Hey everyone! It’s Medicine Mondays and I wanted to talk about an upcoming change to the Maintenance of Certification for the American Board of Psychiatry and Neurology (ABPN). So I’m going to talk about the ABPN MOC Alternative today. This should be a relatively short post (I think).

Stock Photo from: Pexels

First a little background:

In my prior posts about Maintenance of Certification (MOC) and the AMA Update, I’ve talked about recent proposed changes to MOC. To summarize briefly, the prior “standard” was to do a certain amount of CME a year and then take an exam every ten years. Additionally, other things such as the Practice Quality Improvement (PQI) project, and its variants also needed to be done to “maintain certification”.

The first medical board (to my knowledge) that changed this was the American Board of Anesthesiology (ABA) which utilized a new system called the MOCA Minute (now 2.0). It was designed to keep their diplomates up-to-date with practice standards through a series of questions given on a regular basis.

My board, the American Board of Radiology (ABR), started its own pilot which will parallel (or mirror) the ABA. This is still in the works, although I haven’t heard an update from them recently.

I originally wrote those posts back in June 2016, a little more than a year ago.

Back then, there were no plans from the American Board of Psychiatry and Neurology (ABPN), which is my wife’s board, to make any changes to their MOC. She would still be required to take an exam 10 years after her initial certification.

In my AMA Update Blog Post, I discussed the AMA’s disapproval with MOC in its current form as well as the creation of National Board of Physicians and Surgeons (NBPAS), an alternative board. Given all this extenal pressure, I was pretty sure that other boards would follow eventually.

“However, with the advent of NBPAS, and other boards already making changes, I think there is sufficient pressure for all the ABMS specialties to get rid of MOC exams.

Which specialty board will be next? When will the last specialty board drop the MOC exam?”

So what is the ABPN MOC Alternative?

ABPN released a statement on September 5th, 2017 about their MOC Pilot Alternative. Full PDF

I will try my best to cut out the important bits here:

“In this new pilot, diplomates will be given the opportunity to complete repeated self-assessment activities based upon specific literature references selected by a committee of peer diplomates.”

“Eight (8) hours of self-assessment CME credit will now be waived in each 3-year Continuous MOC block.” if participating in a qualified registry

“Eight (8) hours of self-assessment CME credit will now be waived in each 3-year Continuous MOC block.” when diplomates

• pass an ABPN certification or MOC examination
• get a peer reviewed grant approved
• get a peer reviewed paper indexed in a scientific journal
• complete an ABPN-approved non-CME patient safety self-assessment activity
• obtain four (4) hours of documented peer supervision
• or have their clinical performance reviewed by an institutional Peer Review Committee

(emphasis mine)

So, to me it sounds like the ABPN is moving toward what both the ABA and ABR are already piloting. In addition to this, they are providing CME credit for other “educational” activities that their diplomates may already be doing. Once again, I am cautiously optimistic for this change.

What about the American Board of Internal Medicine (ABIM)?

Interesting, the American Board of Internal Medicine (ABIM) is doing something a little different with their “Knowledge Check-In” pilot which will be done every 2 years, and offered between 4-6 times a year. The normal ten year all day exam MOC will be test center only and offered only twice a year.

The 2 year “Knowledge Check-In” examination can be done in your own home, will be “open book”, and will take approximately 3 hours. For 2018, this will start with Internal Medicine and Nephrology, and I imagine will eventually roll out to the other Internal Medicine Specialties.

Which will be better?

It remains to be seen which physicians will prefer.

At first glance, I would prefer the “Knowledge Check-In” alternative other than normal ten year MOC. However, comparing the Knowledge Check-In to the MOCA Minute, I think I would favor the MOCA Minute approach. I was interested to know how the Anesthesiologists like their MOCA Minute program and I stumbled across this blog post from the Great Z.

The author seems to think it went pretty well.

I will quote him here:

“Is it perfect? I think there are a couple of areas that could be improved upon. First get rid of that 60 second timer. It is not relevant at all to the exam. I think it is only there because of the name MOCA Minute. The MOCA Minute ideally should count towards one’s CME requirements. Right now I still need to purchase CME tests for the CME requirements for recertification and state medical licensure. If I’m already spending time reading and learning, why doesn’t the MOCA Minute count towards my CME requirements? It isn’t just about the money, is it? Finally please get ride of Part 4 of MOCA 2.0. It’s purpose is nebulous and just adds more tedium to the already onerous recertification process.”

As for why there a timer, it’s probably because they are trying to see how long it is actually taking people to do the questions. If 100% of the physicians of MOCA Minute are taking longer than a minute for a particular question, that question may either be unusually long or unusually difficult. However, I agree, it does not need to be there and should be relatively simple to hide and just record in the background.

Additionally, he brings up a good point, the CME requirements should be decreased if you’re doing MOCA Minute. They should be considered part of CME.

I also found one comment interesting:

“Stepping back for a moment, the “old” way to recertify was to take a single exam every ten years consisting of 200 questions. Now with MOCA 2.0, the requirement has been increased to 1200 questions to answer during the ten years. On the face of it, something seems wrong. I could understand increasing the requirement from 200 to 400. But 1200 seems absurd. I agree . . . it is a form of hazing.”

Do you want to do 200 questions in one day or 1200 question in 10 years?  In my opinion, I don’t think you can really compare it like that. The whole point of this change was in order to make sure physicians were staying up-to-date with their practice. 120 questions a year (30 questions a quarter) is meant to help make sure we are aware of any changes in our practice.

The 400 questions this commenter suggests averages out to only 40 questions a year. This is only 10 questions per quarter. I think that sample size is way too small in order to establish whether someone is “behind” his/her peers.

Imagine a situation where in a quarter you accidentally got 1 or 2 answers incorrect. This might drop you “behind” your peers and place you “in danger” unnecessarily. Even 30 questions a quarter is probably just above the necessary amount. Most likely, at least 25 questions per quarter is necessary to be sufficiently sensitive/specific to finding those “in danger”.

TL;DR

ABPN has a new MOC Alternative on the way. (as it should!)

ABA is ahead of everyone with their MOCA Minute. ABR is doing something similar.

ABIM is doing its Knowledge Check-In.

Who’s next? Who’s going to be last?

Once again, I remain cautiously optimistic of this change.

What do you guys think?

-Sensei

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

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