Talk:Maintenance of Certification

Article tone is not neutral - is negative off the bat, even though there is some content for both sides of the argument. Sblument (talk) 16:29, 6 November 2014 (UTC)

Copyrighted content has been deleted.

Neutrality

This entire section appears to be little more than a press release that supports the point of view that MOC will lead to improvement in the field of medicine. Another vantage point is that this is simply a way for the ABMS to give credibility to those who argue that there is too high an error rate in the practice of medicine while simultaneously providing a revenue source for their member boards. Physicians will now be spending thousands of dollars more than they would have earlier on programs designed primarily to allow those physicians to meet the new requirements. Whether there truly will be any outcome improvement is a subject of debate. In any case, this section is clearly not designed from a neutral POV and needs to be rewritten without simply being a glowing endorsement of a very hotly debated approach to physician continuing education.Drgitlow (talk) 23:48, 31 December 2007 (UTC)

Additional corrective information

The American Board of Medical Specialties (ABMS) appreciates that Maintenance of Certification is considered a noteworthy topic warranting an article on Wikipedia. However, some of the edits that have been made to the article by third parties present a number of factual inaccuracies, broken/missing links and incomplete, conflicted or dated information. It also appears that some opinionated language (by opposition to MOC) has been added to the article. MOC opponents find no reason to believe ABMS propaganda. Probably a majority of physicians believe MOC is a revenue generating scam by specialty boards and ABMS. Critics point to what they find to be outrageous salaries of specialty board chairs and employees, often multiples of that earned by practitioners in that specialty.

As an organization that represents this concept of initial and continuing certification for physicians, ABMS kindly requests that the Wikipedia editors review the article to clean up these items. MOC opponents are enraged that they are forced to participate in the MOC scam by inappropriate links of MOC to credentialing and insurance participation. Opponents are working hard to overcome these inappropriate links and are actively developing alternatives to MOC. The opposition sees no reason to grant ABMS a monopoly in lifelong learning and appreciates that flexible approaches are probably best.

Some notes include the information below. Citations are shown in bold and noted in the reference section. Many others can be found in the ABMS Evidence Library.

Opening description

Through the Program for Maintenance of Certification (MOC), physicians maintain American Board of Medical Specialties (ABMS) board certification in their chosen specialty by engaging in continuing learning and assessment.

The intent of both board certification and MOC is to assure the public that a physician certified by one (or more) of the ABMS’ 24 Member Boards has met rigorous education, training and assessment standards and thus is well prepared to provide quality care in a particular medical specialty and/or subspecialty. Whether or not MOC meets any of its goals is a matter of intense debate.

The rapid pace at which scientific knowledge evolves and medical procedures and technologies advance make continuous learning and improvement a necessity for physicians. The Program for MOC can help diplomates remain current in their specialties in an increasingly complex practice environment. However, there is no evidence physicians who participate in MOC perform differently from those who do not. Physicians do not want to be forced into AMBS MOC participation and want choices on lifelong learning.

Maintenance of Certification competencies

The Program for MOC addresses six core competencies jointly developed by ABMS and the Accreditation Council for Graduate Medical Education (ACGME) in 1999. Each of ABMS’ Member Boards assess physicians’ proficiency across these competencies that are designed to help define clinical judgment and skills essential for providing high quality patient care. These are the same competencies used in medical residency programs to help guide residents’ education. They are as follows:

• Professionalism—carrying out responsibilities safely and ethically.

• Patient Care and Procedural Skills—providing compassionate, appropriate and effective patient care.

• Medical Knowledge—demonstrating medical knowledge and its application to patient care.

• Practice-based Learning and Improvement—continuously improving patient care through constant self-evaluation and lifelong learning.

• Interpersonal and Communication Skills—facilitating effective information exchange and collaboration with patients, their families and health professionals.

• Systems-based Practice—ability to call on other system resources to provide optimal health care.

Maintenance of Certification components

The Program for MOC includes four component parts that serve to assess and help physicians progress in the core competencies. While ABMS guides the MOC process, each of its Member Boards set the criteria and curriculum for their respective specialty. The activities that comprise the components are based on evidence-based guidelines, national clinical and quality standards and specialty best practices. The components are as follows:

Part I Licensure and Professional Standing—Possession of a valid, unrestricted medical license in at least one state or jurisdiction in the United States, its territories or Canada.

Part II Lifelong Learning and Self-Assessment—Regular participation in educational and self-assessment programs that meet specialty-specific standards developed by each Member Board.

Part III Cognitive Expertise—As demonstrated through a formalized examination, up-to-date practice-related and practice environment-related knowledge necessary to provide quality care in a specialty.

Part IV Practice Performance Assessment—Periodic evaluation of clinical practice to assess the quality of care provided against that of peers and national benchmarks, and application of best evidence or consensus recommendations to improve care.

Maintenance of Certification studies

Because the Program for MOC is relatively young (as it has been introduced gradually during the past decade), evidence about it has emerged in recent years and continues to grow. Preliminary studies show a link between MOC and improved clinical performance and outcomes by participating physicians.1-11 Physician engagement in MOC activities has been associated with enhancement in clinical competence, improvement in care processes and the gathering of valuable patient feedback. Most studies referred to by ABMS were performed and funded by ABMS employees/member boards/ and member board employees all of whom have severe conflicts of interest in maintaining the ABMS MOC monopoly. Furthermore, many of the learning methods used in the Program for MOC have a firm grounding in research and a demonstrated ability to address physician competencies in practice-based learning and improvement.1-3,6,12-19 The latest principles in adult learning are incorporated into MOC activities, such as self-directed practice improvement modules, simulations and interactive workshops. Most of the Member Boards use similar approaches in their performance improvement activities. Little evidence exists to support the huge cost of MOC and its imposition on unwilling physicians, who really want alternatives and flexibility to keep current. These studies reinforce prior research that has shown a positive link between initial ABMS board certification and quality of care.20-34 The latter range from lower mortality rates for patients with acute myocardial infarction and colorectal surgery to improved preventive care services for Medicare patients when such care is delivered by a Board Certified specialist. These studies and other independent research findings that support the value of board certification and MOC are housed in the ABMS Evidence Library. This online resource is a searchable, convenient database to which references and annotations will be added over time and as new literature emerges.

Maintenance of Certification and the medical community

Major medical associations recognize the value of the ABMS Program for MOC. Among them are:

• The American Medical Association
• The American Hospital Association (AHA)
• The National Board of Medical Examiners (NBME)
• The Federation of State Medical Boards (FSMB)
• The Council of Medical Specialty Societies (CMSS)
• The Accreditation Council for Graduate Medical Education (ACGME)
• The Accreditation Council for Continuing Medical Eduction (ACCME)
• The Association of American Medical Colleges (AAMC)
• The Educational Commission for Foreign Medical Graduates (ECFMG)

Regarding physicians, studies have shown that specialists believe in the value of MOC.39,41 Specifically, specialists believe that those providing patient care should maintain certification. Many say that a main reason for participation in MOC is to update their knowledge. Physicians report that their experience with components of MOC, such as practice improvement modules and examinations, has been beneficial. 6,13-14,35-38,40-42 Among the cited benefits are identifying areas for improvement in practice, providing valuable patient feedback and generating high quality performance data.

Patients Support Maintenance of Certification

An overwhelming majority of patients believe that it is important for physicians to maintain certification, according to consumer surveys. 20,43-45 In one such study, if respondents found out that their physician does not maintain certification, most would look for a new one or cease referring that physician. Patients and family members routinely check their physicians’ certification status at Certification Matters; more than 1.5 million searches were conducted in 2012 alone. It should be noted that these studies were almost entirely the work of ABMS or its members nad were not independently reviewed. It appears to be but one arm of a multipronged approach by ABMS, along with pandering to insurance and hospital associations, to maintain its financial grip on physicians. Board certification is a trophy, earned through years of study, hard work, and dedication. Like an Olympic medal or Purple Heart, it is yours to keep. Continuing medical education to maintain a state medical license is the responsibility of state medical boards. ABMS has no role.

References

1. Duffy FD, Lynn LA, Didura H, Hess B, Caverzagie K, Grosso L, et al. Self-assessment of practice performance: development of the ABIM practice improvement module (PIM). J Contin Educ Health Prof 2008;28(1):38-46.

2. Hagen MD, Ivins DJ, Puffer JC, Rinaldo J, Roussel GH, Sumner W, et al. Maintenance of certification for family physicians (MC-FP) self assessment modules (SAMs): the first year. J Am Board Fam Med 2006;19(4):398-403.

3. Hagen MD, Sumner W, Fu H. Diuretic of choice in ABFM hypertension self-assessment module simulations. J Am Bboard Fam Med 2012;25(6):805-9.

4. Hess BJ, Weng W, Holmboe ES, Lipner RS. The association between physicians’ cognitive skills and quality of diabetes care. Acad Med 2012;87(2):157-63.

5. Hess BJ, Weng W, Lynn LA, Holboe ES, Lipner RS. Setting a fair performance standard for physicians’ quality of patient care. J Gen Intern Med 2010;26(5):463-73.

6. Holmboe ES, Meehan TP, Lynn L, Doyle P, Sherwin T, Duffy FD. Promoting physicians’ self-assessment and quality improvement: the ABIM diabetes practice improvement module. J Contin Educ Health Prof 2006;26(2):109-19.

7. Holmboe ES, Wang Y, Meehan TP, Tate JP, Ho SY, Starkey KS, et al. Association between maintenance of certification examination scores and quality of care for Medicare beneficiaries. Arch Intern Med 2008;168(13):1396-403.

8. Mandel KE, Kotagal UR. Pay for performance alone cannot drive quality. Arch Pediatr Adolesc Med 2007;161(7):650-5. (An ABP MOC-approved Part IV activity.) 9. Miles PV. Maintenance of certification: the profession’s response to physician quality. Ann Fam Med 2011;9(3):196-7.

10. Miller MR, Griswold M, Harris JM II, Yenokyan G, Huskins C, Moss M. Decreasing PICU catheter-associated bloodstream infections: NACHRI’s quality transformation efforts. Pediatrics 2010;125(2):206-12. (An ABP MOC-approved Part IV activity.)

11. Turchin A, Shubinna M, Chodos AH, Einbinder JS, Pendergrass ML. Effect of board certification on antihypertensive treatment intensification in patients with diabetes mellitus. Circulation 2008;117:623-8.

12. Davis D, Evans M, Jadad A, Perrier L, Rath D, Ryan D, et al. The case for knowledge translation: shortening the journey from evidence to effect. BMJ 2003;327;33-5.

13. Holmboe ES, Cassel C. Continuing medical education and maintenance of certification: essential links. The Permanente Journal 2007;11(4):71-5.

14. Holmboe ES, Lipner R, Greiner A. Assessing quality of care: knowledge matters. JAMA 2008;299(3):338-40.

15. Oyler J, Vinci L, Arora V, Johnson J. Teaching internal medicine residents quality improvement techniques using the ABIM’s practice improvement modules. J Gen Intern Med 2008;23(7):927-30.

16. Thomson O’Brien T, Freemandle N, Oxman AD, Wolf F, Davis DA, Herrin J. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2001;(2):CD003030.

17. Sheehan J, Starke RM, Pouratian N, Litvack Z, Asthagiri A. Identification of knowledge gaps in neurosurgery through analysis of responses to the self-assessment in neurological surgery (SANS). World Neurology 2012;Oct 5. pii:S1878-8750(12)01098-4. doi: 10.1016/j.wneu.2012.05.033. [Epub ahead of print]

18. Sheehan J, Starke RM, Pouratian N, Litvack Z. Identification of knowledge gaps in neurosurgery using a validated self-assessment examination: differences between general and spinal neurosurgeons. World Neurology 2012;Sep 16. pii:S1878-8750(12)01031-5. doi: 10.1016/j.wneu.2012.09.007. [Epub ahead of print]

19. Steadman RH, Huang YM. Simulation for quality assurance in training, credentialing and maintenance of certification. Best Pract Res Clin Anaesthesiol 2012;126(1): 3-15.

20. Brennan TA, Horwitz RI, Duffy FD, Cassel CK, Goode LD, Lipner RS. The role of physician specialty board certification status in the quality movement. JAMA 2004;292(9):1038-43.

21. Chen J, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Physician board certification and the care and outcomes of elderly patients with acute myocardial infarction. Journal of General Internal Medicine 2006:21;238-44.

22. Curtis JP, Leubbert JJ, Wang Y, Rathora SS, Chen J, Heidenreich PA, et al. association of physician certification and outcomes among patients receiving an implantable cardioverter-defibrillator. JAMA 2009;16:1661-70.

23. Hanson KL, Butts GC, Friedman S, Fairbrother G. Physician credentials and practices associated with childhood immunization rates: private practice pediatricians serving poor children in New York City. Journal of Urban Health 2001;78:112-24.

24. Holmboe ES, Weng W, Arnold GK, Kaplan SH, Normand SL, Greenfield S, et al. The comprehensive care project: measuring physician performance in ambulatory practice. Health Serv Res 2010;45(Pt 2):1912-33.

25. Khaliq AA, Dimassi H, Huang CY, Narine L, Smego RA. Disciplinary action against physicians: who is likely to get discipline? American Journal of Medicine 2005:118;773-7.

26. Kohatsu ND, Gould D, Ross LK, Fox PJ. Characteristics associated with physician discipline: a case-control study. Archives of Internal Medicine 2004:164;653-8.

27. Masoudi FA, Gross CP, Wang Y, Rathore SS, Havranek EP, Foody JA, et al. Adoption of spironolactone therapy for older patients with heart failure and left ventricular systolic dysfunction in the United States, 1998-2001. Circulation 2005;112:39-47.

28. Norcini JJ, Kimball HR, Lipner RS. Certification and specialization: do they matter in the outcome of acute myocardial infarction? Acad Med 2000;75(12):1193-8.

29. Norcini J J, Lipner RS, Kimball HR. Certifying examination performance and patient outcomes following acute myocardial infarction. Medical Education 2002:36;853-9.

30. Orler RL, Friedberg MW, Adams JL, McGlynn EZ, Mehrotra A. Associations between physician characteristics and quality of care. Arch Intern Med 2010;170(16):1442-9.

31. Pham HH, Schrag D, Hargraves JL, Bach PB. Delivery of preventive services to older adults by primary care physicians. JAMA 2005;294(4):473-81.

32. Prystowsky JB, Bordage G, Feinglass JM. Patient outcomes for segmental colon resection according to surgeon’s training, certification, and experience. Surgery 2002;132(4):663-70.

33. Sharp LK, Bashook PG, Lipsky Ms, Horowitz SD, Miller SH. Specialty board certification and clinical outcomes: the missing link. Acad Med 2002;77(6):534-42.

34. Silber JH, Kennedy SK, Even-Shoshan O, Chen W, Mosher RE, Showan AM, et al. Anesthesiologist board certification and patient outcomes. Anesthesiology 2002;96:1044-52.

35. ABIM MOC program survey results. January 2008-January 2011.

36. ABIM PIM survey results. January 2011-July 2012.

37. ABIM SEP modules survey results. July 2009-January 2012.

38. Anson, JA. MOCA® saves a life: letters to the editor. ASA Newsletter 2013;77(1):47. http://viewer.zmags.com/publication/dd2b8bfd. (Accessed Jan. 16, 2013.)

39. Freed GL, Dunham KM, Althouse LA. Characteristics of general and subspecialty pediatricians who choose not to recertify. Pediatrics 2008;121(4): 711-7.

40. Levinson W, Holmboe E. Maintenance of certification in internal medicine: facts and misconceptions. Arch Intern Med 2011;171(2):174-6.

41. Lipner RS, Bylsma WH, Arnold GK, Fortna GS, Tooker J, Cassel CK. Who is maintaining certification in internal medicine—and why? A national survey 10 years after initial certification. Ann Intern Med 2006:144:29-36.

42. Miles PV. The future of maintenance of certification: a reaction to the paper by Kevin B. Weiss, MD. J Am Board Fam Med 2010;23(Suppl):542-5.

43. American Board of Medical Specialties. Facts about the 2010 ABMS consumer study: lifelong learning and other qualities in choosing a doctor. www.abms.org.

44. American Board of Medical Specialties. Facts about the 2008 ABMS consumer study: how Americans choose their doctors. www.abms.org.

45. Freed GL, Dunham KM, Clark SJ, Davis MM. Perspectives and preferences among the general public regarding physician selection and board certification. J Pediatr 2010;156:841-5.

Lboukas (talk) 14:10, 25 November 2013 (UTC)

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