Hi guys, Happy President’s Day! This will be a short post about the Online Longitudinal Assessment (OLA). This will be the replacement for the current iteration of MOC for the American Board of Radiology.

Stock Photo from: Pexels

You may recall my prior posts about the Maintenance of Certification (MOC):

Maintenance of Certification (MOC)

Maintenance of Certification – AMA Update

If you haven’t already, you should probably read those first to give you a background on what I am talking about today. However, the TL;DR is that The American Board of Radiology is moving away from the old process of a 10 year comprehensive examination for MOC. Instead, the plan is to implement something similar to what Anesthesiology has already implemented, which is called the MOCA Minute. Something along the lines of doing weekly modules with questions/answers to maintain certification.

So what is Online Longitudinal Assessment?

The American Board of Radiology recently filed for a trademark of “Online Longitudinal Assessment”. Filing here.

The American Board of Radiology sent out an update during the summer of 2016, around July or so, updating their diplomates on what their plan was. You can find the official press release here. They also created a Frequently Asked Questions (FAQ) pdf as well, which you can find here.

However, I will spare you all that reading and condense it down to what I think is important:

• If you need to pass the MOC by March 2, 2017… unfortunately, you will still need to do the normal MOC exam. Sorry.
• However, for those don’t need it until after March 2, 2017, you don’t need the MOC exam, and can go ahead and cancel it. The ABR will defer your requirement until after you the new Online Longitudinal Assessment is ready.
• Additionally, for those who have subspecialty certification in Hospice and Palliative Medicine and Pain Medicine, you must adhere to those boards.
• Once the new OLA rolls out, it will not matter when you took your last MOC exam. Everyone must participate in OLA once implemented. (the same as Anesthesia did)
• The pilot will begin in mid-late 2018. The OLA will probably be ready sometime in mid 2019.
• You will choose a “clinical practice profile” to better approximate your normal workflow.
• Then you will receive weekly emails to questions clinically relevant to your practice.
• If preferred, you can do them weekly, or in small batches. (I imagine there is like a 4-8 week “expiration” on them.)
• Correct answers will immediately receive an explanation and brief education.
• Incorrect answers will prompt future questions in the same category to fill knowledge gaps.

So what do you think Sensei?

Like I said in my prior posts, I think this is a step in right direction. I’ve never liked the idea of taking an exam every 10 years. I think that instills “the need to learn” once every 10 years. This is the opposite of the “Continuing Medical Education” and “Lifelong Learning” ideals of medicine.

It didn’t make sense to take an exam once every 10 years to “prove” that you were up to date. Doctors are human, we are going to focus on the things that are the most important in our clinical practice. For example, I’m a neuroradiologist, but I still read pretty much all of radiology, except mammography. In my line of work (teleradiology) it doesn’t really make sense for me to read it. For that reason, if I was in my current job for 10 years and needed to take the MOC, I would have to essentially relearn mammography for the exam, because it is comprehensive. Or, on the other side of the coin, if one was to read mammography only, they would need to brush up on all the other aspects of radiology for their MOC.

This seems inefficient, and doesn’t really make sense. Like I said, it fosters a “need to study” once every 10 years, rather than continuous learning.

Any other concerns?

A continuous assessment makes sense. However, I do wonder how they are going utilize the “practice profile” that radiologists create. To continue with my example above, most likely my practice profile would be something like “subspecialty trained in neuroradiology”, but “read all examinations”, “except mammography”.

Does that mean that I will be assigned less mammography questions on average? Is there a ratio involved? Or will I receive proportionately more questions (ie. higher weighting) in mammography than other sections because I don’t read it anymore?

I don’t know. I’m not sure how they plan to utilize the practice profile.

What do you think about the questions being “weekly”?

Honestly, this depends on how well the OLA is implemented. If it’s simple and easy to access, such as an app with good UX/UI that can be done in any downtime situation, then weekly should work just fine. Perhaps you could even tell the app to remind you on a set schedule.

For example, let’s say you have every Sunday morning off, then it would just remind you every Sunday Morning at 9 or 10 am (or whatever) to do your questions while you’re drinking your morning coffee. Seems pleasant.

However, if it cumbersome and only accessible via the web, and then has accessibility problems based on browser types, then perhaps monthly would work better.

For example, you could set it to send you the monthly  batch of questions on a certain day of each month, at a certain time. Then you would receive a reminder maybe a week prior that you will receive the batch of questions, just in case your plans have changed and would need to do them ahead of time.

I see… is the ABR going to build an app then?

From the FAQ, it seems like they are starting with email and links to questions for now. This is fine.

However, I hope they move foward with an iOS/Android app at some point. MOCA Minute from the American Board of Anesthesiology already have an app. However, I am not sure how good it is.

Ty, an anesthesiologist commented that he had been having browser issues, which they haven’t been able to fix yet. Here

The long and short of it is “Don’t Make Me Think“.

Doctors are busy people, the reason we don’t like MOC (in general) is because it is cumbersome. If it was streamlined and provided education relevant to us and our practice, I think we would take advantage of it. However, it needs to show value and be relevant to us.

For example, it needs to be more valuable than a 20 hour, 50 CME course where we are just blasted with information. Then a week later, we probably retain very little of the course that was relevant to our day to day practices. Use it or lose it.

Wait, are these questions being scored?

I don’t know how the ABR is planning to score or how it will affect MOC. However, the American Board of Anesthesia has implemented something called the Measurement Decision Theory (MDT). My summary of that video is:

It’s basically the APA’s way of separating people who are “up-to-date” versus “not up-to-date”. They are very specific about it calling a “probability” and “not a score”.

Basically, if you eventually fall into the “not up-to-date” group, and are considered in danger of losing MOC, you will be contacted and a plan will be created to move you back into the up-to-date group. While you can see your “score” meaning % correct, that is not your MDT.

Additionally, there is no curve, so technically, everyone can be in the up-to-date group. Another important point is that if you answer a question incorrectly, but then answer the same or similar question correctly later on, then you will receive credit for the original question. It also appears that questions may be weighted in importance depending on how many people got it right/wrong.

I imagine that the ABR will do something similar to the above, if not exactly the same.

Do you think that the other board certifications will follow suit?

Yes. It’s really a matter of when rather than if. 10 year MOC examinations are a relic of the past when accessibility was difficult and it was difficult to obtain/evaluate large amounts of data. However, in this day in age, it does not make sense to continually make your diplomates fly somewhere to take a comprehensive test every 10 years.

The only relevance that examination has on whether the diplomate is up-to-date or not is how well they studied for the exam. It does nothing to demonstrate what their fund of knowledge over the previous 10 years was on a day-to-day basis.

As far as I know, The American Board of Anesthesia (ABA) is way ahead of everyone else here. However, The American Board of Radiology (ABR) should be considered “early adopters“. Additionally, the “biggest elephant”, The American Board of Internal Medicine (ABIM) has taken note. They are expected to offer an alternative in 2018. – Source

For all the other specialty and subspecialty boards, I would recommend you at least put together something similar to the above on paper. You don’t want to be scrambling to throw things together in 2018 when even the ABIM has something similar to MOCA Minute and you don’t. Please listen to your diplomates and don’t just wait until everyone else does it first.

To be honest, not getting rid of the 10 year MOC exam is a disservice to your diplomates.

TL;DR

Online Longitudinal Assessement is ~ the ABR”s version of MOCA Minute.

Currently, it’s looking like a email/web based weekly questions. I expect this to evolve with time, and would expect the ABR to develop their own app like the ABA did.

ABA utilizes an interesting MDT model for evaluation of up-to-date practitioners versus non up-to-date practitioners. (See above)

I think all boards should (and hopefully will) move away from 10 year exams in the next 5 years. If they don’t, it’s honestly a disservice to their diplomates.

-Sensei

Did I miss anything? What do you think?

Is there another board doing something differently? Let me know!

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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