On December 11, 2018, a 27-member independent commission put together by the American Board of Medical Specialties (ABMS) released a draft report focused on the maintenance of certification (MOC) process.
The Commission, the Continuing Board Certification: Vision for the Future Commission, included a variety of stakeholders, including: practicing physicians, health care leadership, academic medicine, group medical practices, state and national medical associations, ABMS Board executives, specialty societies, and health advocate groups. The Commission was tasked with reviewing MOC within the current medical professional, including addressing key issues that face ABMS Boards and diplomates as they work together to fulfill their commitment to patients and families, as well as professional colleagues.
In drafting the report, the Commission heard over 21 hours of public testimony and testimony about the operations and finances of select ABMS Boards. Throughout the testimony, the Commission heard a relatively consistent commitment to a continuing certification system and the majority of the testimony heard did not support a return to lifetime certification.
Some diplomates provided testimony that acknowledged that colleagues who were lifetime certificate holders should participate in some system to keep current. However, other stakeholders, especially physician stakeholders, thought that the continuing certification system should only consist of an active state license and continuing medical education (CME) requirements.
Based on the report, many physicians have complaints about MOC. An online survey conducted for the commission that included more than 34,000 physicians found that roughly one in ten (12%) said they found value in MOC. Nearly half (46%) said they have “mixed feelings” about the program, and 41% said they do not value the program. “In summary, approximately half of respondents see MOC as too costly, burdensome and not a true reflection of their abilities as clinicians,” the report said.
When asked how they would like to see MOC changed, a majority of physicians responded with a desire for continuing certification to focus on practice-relevant continuing medical education (84%) or self-assessment questions delivered at regular intervals (52%). Less popular choices were open-book exams and quality and safety of care assessments.
Commission Recommendations
The recommendations are organized into four categories: Expectations for Continuing Certification Programs, Stakeholders in Continuing Certification, Research and Evaluation of Continuing Certification, and ABMS Boards’ Support of Diplomates.
Expectations for Continuing Certification Programs
Some of the recommendations in this category include: continuing certification should constitute an integrated program with standards for professionalism, assessment, lifelong learning, and practice improvement; professionalism is an important competency for which specialty-developed performance standards for certification must be implemented; and standards for learning and practice improvement must expect diplomate participation and meaningful engagement in both lifelong learning and practice improvement, ABMS Boards should seek to integrate readily available information from a diplomate’s actual clinical practice into any assessment of practice improvement.
Stakeholders in Continuing Certification
The recommendations in this category include: ABMS Boards should collaborate with professional and CME/CPD organizations to create a continuing certification system that serves the public while supporting diplomates in their commitments to be better physicians.
Research and Evaluation of Continuing Certification
Included in this category were: ABMS and ABMS Boards should collaborate with other organizations to facilitate and encourage independent research; and ABMS Boards must collectively engage in a regular continuous quality improvement process and improve the effectiveness and efficiency of continuing certification programs.
ABMS Boards’ Support of Diplomates
Recommendations here included that ABMS Boards comply with all ABMS certification and organizational standards; continuing education should be structured to expect diplomate participation on an annual basis; ABMS Boards must regularly communicate with their diplomates about the standards for the specialty and to foster feedback about the program; and ABMS Boards should facilitate reciprocal longitudinal pathways that enable multi-specialty diplomates to remain current in multiple disciplines across ABMS Boards without duplication of effort or excessive requirements.
The Commission also recommended that the term “Maintenance of Certification” be abandoned and that a new term that communicates the concept, intent and expectations of future continuing certification programs should be adopted.
The commission asked for comments to be submitted on the draft report and will review the comments it receives and meet one last time to make revisions to the draft before submitting its final report to the ABMS Board of Directors in February.