Maintenance of Certification Program Does Not Result in Performance Improvement

The medical community relies on intellectual improvement in physician practices in order to stay current with new clinical knowledge. However, ways of implementing improvement in clinical performance, recertification processes, and patient outcomes are debated in a recent opinion piece published in JAMA.¹

The American Board of Medical Specialties (ABMS) established the Maintenance of Certification (MOC) program, which was comprised of key factors such as professionalism, lifelong learning, self-assessment, and quality improvement. 

It is reported that MOC has conflicting data supporting whether their program does indeed result in performance improvement. MOC stated it has an 80% improvement rate and 38.9% outcome measure. However, 2 inclusive studies consisting of 2000 internal medical physicians did not exhibit an uptick in professional improvement.

Some physicians declare the MOC program is an inefficient use of their time and effort. A main concern with the MOC program that makes it unpopular with physicians is the last step of the program: a written standardized pass-fail exam testing cognitive expertise.

However, physicians perceived a lack of contemporary relevance in the examination that ultimately does not result in the upkeep of new clinical components in their practice. Significant financial and emotional stress goes into preparation for the exam, and physicians who fail potentially face a loss of privileges or their livelihood.

A total of 22,000 physicians petitioned for the recall of MOC. The National Board of Physicians and Surgeons (NBPAS) offers alternative recertification processes for all American Board of Medical Specialties (ABMS) for over 3000 physicians. The NBPAS does not require an examination or practice improvement. 

“NBPAS requires previous certification by an ABMS member board; 50 hours of accredited continuing medical education in 24 months; a valid, unrestricted license to practice medicine; active privileges to practice that specialty at an accredited hospital for procedural specialties; and no history of permanently revoked hospital privileges in their specialty.”

Other medical institutions have recommended changes to the MOC program, such as the removal of the pass-fail exam and other improvements in the quality of current information. For example, the American College of Cardiology (ACC) has made tremendous efforts to make the American Board of Internal Medicine (ABIM) a more conclusive, concentrated assessment for the recertification process.

The feedback from the MOC program has been utilized as it creates “alternative formats that include elements common to all boards and distinct learnings and assessments appropriate for individual specialties; new examination formats representing a movement toward frequent knowledge testing to provide feedback rather than make pass-fail decisions.” The ABMS Multi-Specialty Portfolio Program has introduced more than 1800 initiatives for improvement in physician practices within healthcare institutions.

Patients rely on medical institutions to ensure that physicians are up to date with clinical information and recertification processes. The latter are pertinent to the practicing medical community, as ABMS and MOC programs continue to “maintain standards appropriate for a self-regulating profession, while meeting physicians’ needs and desires to have a high-quality program for lifelong learning and practice improvement, is a more productive course of action than offering approaches to recertification that are less rigorous and thus, less meaningful to patients and their physicians.”

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Reference

1. Welcher CM, Kirk LM, Hawkins RE. Alternative Pathways to Board Recertification: To What End?. JAMA. 2017;317(22):2279-2280.

This article originally appeared on Medical Bag