Attempting to document continued competency in medical practice is challenging, not just for allergy/immunology, but also for all the primary specialties and sub-specialties served by the American Board of Medical Specialties (ABMS). I initially hesitated to devote a College Insider column to Maintenance of Certification (MOC). In part because it is a hot button area for some of our members, but also because of my own conflict of interest as a member of the American Board of Allergy and Immunology (ABAI). However, significant changes are taking place in the ABAI MOC process that I believe are of interest to College members, including the emergence of inherent flexibility of certain MOC requirements. I therefore decided to share my perspective.
Assessment of Core Knowledge (MOC Part III)
As many of you already know, the ABAI is transitioning to a “Continuous Assessment Program” (CAP) to replace the “every 10 year” secure examination. CAP will fundamentally change how we satisfy the Part III MOC requirement, and, so far, most College members report cautious optimism regarding this change. This new system is an open book, web-based, and self-paced assessment program. Every six months the diplomate will be required to answer a total of 40 questions: 10 will be “general knowledge” questions and 30 will be “article-based” questions.. Starting in 2018, every January and July the ABAI will announce 12-15 articles spanning eight topic domains that will serve as the basis for the “article-based” questions. Diplomates will choose 10 of these articles for an assessment, answering three questions per article.
There are several flexible features of CAP that should reduce the pain. First, diplomates do not have to answer questions about all the articles; instead they choose 10 articles from a list of 12-15. Diplomates also may choose the pace of the assessment. For example, every six months they may choose to answer questions on one article and one General Knowledge item each week for 10 weeks, or perhaps choose to take all 40 questions in one day every six months. In addition to meeting MOC Part III requirements, diplomates earn CME for these activities, with the granting of CME alternating between the College and Academy every six months.
Practice Improvement (MOC Part IV)
How about Part IV of MOC? This is the “Practice Improvement” component required by the ABMS. Each of the currently available modules is well-intentioned and valid. Many of us (myself included) think it should be possible to obtain Part IV credit for activities we are already doing, and that the process should be less cumbersome. In response to this, the ABAI is developing two new modules. One is designed for academic diplomates and the other for diplomates who either mentor or supervise others, including residents, Fellows, junior colleagues, physician extenders, nurses, and other office staff. These modules are purposely flexible and simplified to be more adaptable to a diplomate’s unique work circumstance, while still serving to document important practice improvement activity.
How is the College Helping?
Although the ABAI is an independent body, increasing flexibility regarding the diplomate’s Part III and Part IV MOC experience has opened the door for the College to assist in lessening the burden associated with MOC. For example, an open book examination primarily addressing a small list of important articles offers the opportunity for featuring relevant MOC articles in Annual Scientific Meeting sessions, AllergyWatch, and other media. In addition, to support members toward completing the Part IV “supervision” module, the College is discussing the possible development of a bank of “tools” that might be used for data collection, such as a questionnaire for evaluating residents before and after an allergy office rotation.
Just recently the College announced the availability of the “Safe Steroid Use” Self-Assessment Module. By completing this new educational activity, College members will satisfy the ABAI’s MOC Patient Safety requirement and earn MOC Part II Self-Assessment credits.
The 2017-2018 MOC transition by no means resolves all the stress associated with maintaining board certification, but it is certainly a step in the right direction. By removing a large once-a-decade proctored exam and increasing flexibility for diplomates, the ABAI has opened the door for streamlining the once separate CME and MOC experiences. Please rest assured the College is prepared to help lessen the pain further.
Stephen A. Tilles, MD, FACAAI