GASTROENTEROLOGY

Maintenance of Certification (MOC) Examination Blueprint

®

ABIM invites diplomates to help develop the Purpose of the Gastroenterology MOC exam
Gastroenterology MOC exam blueprint The MOC exam is designed to evaluate whether a certified
Based on feedback from physicians that MOC assessments gastroenterologist has maintained competence and currency
should better reflect what they see in practice, in 2016 the in the knowledge and judgment required for practice. The
American Board of Internal Medicine (ABIM) invited all certified exam emphasizes diagnosis and management of prevalent
gastroenterologists to provide ratings of the relative frequency conditions, particularly in areas where practice has changed
and importance of blueprint topics in practice. in recent years. As a result of the blueprint review by ABIM
This review process, which resulted in a new MOC exam diplomates, the MOC exam places less emphasis on rare
blueprint, will be used on a periodic basis to inform and conditions and focuses more on situations in which physician
update all MOC assessments created by ABIM. No matter intervention can have important consequences for patients.
what form ABIM’s assessments ultimately take, they will need For conditions that are usually managed by other specialists,
to be informed by front-line clinicians sharing their perspective the focus is on recognition rather than on management.
on what is important to know.
Exam format
A sample of over 400 gastroenterologists, similar to the total
The exam is composed of 240 single-best-answer multiple-
invited population of gastroenterologists in age, gender,
choice questions, of which 40 are new questions that
time spent in direct patient care, and geographic region of
do not count in the examinee’s score (more information
practice, provided the blueprint topic ratings. The ABIM
on how exams are developed can be found at
Gastroenterology Exam Committee and Board have used
abim.org/about/exam-information/exam-development.aspx).
this feedback to update the blueprint for the MOC exam
(beginning with the Spring 2017 administration). Most questions describe patient scenarios and ask about
the work done (that is, tasks performed) by physicians in
To inform how exam content should be distributed across the course of practice:
the major blueprint content categories, ABIM considered the
average respondent ratings of topic frequency and importance • Diagnosis: making a diagnosis or identifying an
in each of the content categories. A second source of information underlying condition
was the relative frequency of patient conditions in the content • Testing: ordering tests for diagnosis, staging, or follow-up
categories, as seen by certified gastroenterologists and • Treatment/Care Decisions: recommending treatment or
documented by national health care data (described further other patient care
under Content distribution below).
• Risk Assessment/Prognosis/Epidemiology: assessing
To determine prioritization of specific exam content within each risk, determining prognosis, and applying principles from
major medical content category, ABIM used the respondent epidemiologic studies
ratings of topic frequency and importance to set thresholds for
• Pathophysiology/Basic Science: understanding the
these parameters in the exam assembly process (described
pathophysiology of disease and basic science knowledge
further under Detailed content outline below).
applicable to patient care

JANUARY 2018 1
Clinical scenarios presented take place in outpatient or inpatient How the blueprint ratings are used to assemble
settings as appropriate to a typical gastroenterology practice. the MOC exam
Clinical information may include patient photographs, imaging
Blueprint reviewers provided ratings of relative frequency in
studies, electrocardiograms, endoscopic videos, and other
practice for each of the detailed content topics in the blueprint
media to illustrate relevant patient findings.
and provided ratings of the relative importance of the topics
A tutorial, including examples of ABIM exam question format, for each of the tasks described in Exam format above. In rating
can be found at abim.org/maintenance-of-certification/exam- importance, reviewers were asked to consider factors such
information/gastroenterology/exam-tutorial.aspx. as the following:
• High risk of a significant adverse outcome
Content distribution
• Cost of care and stewardship of resources
Listed below are the major medical content categories that
define the domain for the Gastroenterology MOC exam. The • Common errors in diagnosis or management
relative distribution of content is expressed as a percentage • Effect on population health
of the total exam. To determine the content distribution,
• Effect on quality of life
ABIM considered the average respondent ratings of topic
frequency and importance. To cross-validate these self-reported • When failure to intervene by the physician deprives a
ratings, ABIM also considered the relative frequency of patient of significant benefit
conditions seen in Medicare patients by a cohort of certified Frequency and importance were rated on a three-point scale
gastroenterologists. Informed by these data, the Gastroenterology corresponding to low, medium, or high. The median importance
Exam Committee and Board have determined the medical ratings are reflected in the Detailed content outline below. The
category targets, shown below. Gastroenterology Exam Committee and Board, in partnership
with the physician community, have set the following param-
eters for selecting MOC exam questions according to the
blueprint review ratings:
• At least 75% of exam questions will address
CONTENT CATEGORY Target %
high-importance content (indicated in green)

Esophagus 12% • No more than 25% of exam questions will address
medium-importance content (indicated in yellow)
Stomach and Duodenum 15%
• No exam questions will address low-importance content
Liver 22% (indicated in red)
Independent of the importance and task ratings, no more than
Biliary Tract 10%
17% of exam questions will address low-frequency content
Pancreas 11% (indicated by “LF” following the topic description).

Small Intestine 10%

Colon 20%

Total 100%

Exam questions in the content areas above also may address

topics in endoscopy, genetic conditions, medication management
and risks, nutritional support, and quality benchmarking.

JANUARY 2018 2
 The content selection priorities below are applicable beginning with the Spring 2017 MOC exam and are
subject to change in response to future blueprint review.

Note: The same topic may appear in more than one medical content category.

Detailed content outline for the Gastroenterology MOC exam

– High Importance: At least 75% of exam – Medium Importance: No more than 25% – Low Importance: No exam questions
questions will address topics and tasks of exam questions will address topics and will address topics and tasks with
with this designation. tasks with this designation. this designation.

LF – Low Frequency: No more than 17% of exam questions will address topics with this designation, regardless of task or importance.

Risk Assessment/
ESOPHAGUS Treatment/ Prognosis/ Pathophysiology/
(12% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (<2% of exam)

Anatomic abnormalities LF

Esophageal physiology

SYMPTOMS AND CLINICAL PRESENTATION (<2% of exam)

Dysphagia

Heartburn

Chest pain

Globus sensation

DISEASES AND DISORDERS (10% of exam)

Oropharyngeal disorders

Esophageal motility and functional disorders

Achalasia LF

Gastroesophageal reflux disease

(GERD)

Barrett’s esophagus

Foreign body and food impaction

Esophageal injury LF

Esophageal infections LF

JANUARY 2018 3
 – High Importance: At least 75% of exam – Medium Importance: No more than 25% – Low Importance: No exam questions
questions will address topics and tasks of exam questions will address topics and will address topics and tasks with
with this designation. tasks with this designation. this designation.

LF – Low Frequency: No more than 17% of exam questions will address topics with this designation, regardless of task or importance.

ESOPHAGUS
continued… Risk Assessment/
Treatment/ Prognosis/ Pathophysiology/
(12% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

DISEASES AND DISORDERS continued… (10% of exam)

Neoplasms of the esophagus

Benign LF

Malignant

Esophageal ulcerations

Eosinophilic esophagitis

Esophageal varices

Systemic disorders involving the

LF
esophagus

Risk Assessment/
STOMACH AND DUODENUM Treatment/ Prognosis/ Pathophysiology/
(15% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (<2% of exam)

Anatomic abnormalities LF

Physiology of the stomach and

duodenum

SYMPTOMS AND CLINICAL PRESENTATION (3% of exam)

Upper gastrointestinal bleeding

Dyspepsia and upper abdominal

pain

Nausea and vomiting

DISEASES AND DISORDERS (10.5% of exam)

Gastric mucosal disorders

Helicobacter pylori

Medication-induced

Neoplasms of the stomach and duodenum

Benign

Malignant LF

JANUARY 2018 4
 – High Importance: At least 75% of exam – Medium Importance: No more than 25% – Low Importance: No exam questions
questions will address topics and tasks of exam questions will address topics and will address topics and tasks with
with this designation. tasks with this designation. this designation.

LF – Low Frequency: No more than 17% of exam questions will address topics with this designation, regardless of task or importance.

STOMACH AND DUODENUM

continued… Risk Assessment/
Treatment/ Prognosis/ Pathophysiology/
(15% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

DISEASES AND DISORDERS continued… (10.5% of exam)

Gastric motility and functional

disorders

Post-surgical conditions

Bariatric surgery

Gastric resection LF

Surgery for benign disease LF

Surgery for malignant disease LF

Risk Assessment/
LIVER Treatment/ Prognosis/ Pathophysiology/
(22% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (2% of exam)

Anatomic abnormalities LF

Hepatic physiology

SYMPTOMS AND CLINICAL PRESENTATION (2% of exam)

Abnormal liver chemistries

Jaundice

Portal hypertension

Varices

Ascites and hepatic hydrothorax

Hepatorenal syndrome LF

Portosystemic encephalopathy

Pulmonary complications LF

Pruritus LF

JANUARY 2018 5
 – High Importance: At least 75% of exam – Medium Importance: No more than 25% – Low Importance: No exam questions
questions will address topics and tasks of exam questions will address topics and will address topics and tasks with
with this designation. tasks with this designation. this designation.

LF – Low Frequency: No more than 17% of exam questions will address topics with this designation, regardless of task or importance.

LIVER
continued… Risk Assessment/
Treatment/ Prognosis/ Pathophysiology/
(22% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

DISEASES AND DISORDERS (18% of exam)

Inherited disorders

Iron overload LF

Wilson’s disease LF

Alpha-1 antitrypsin deficiency LF

Cystic fibrosis LF

Sickle cell hepatopathy LF

Cholestatic liver diseases

Primary biliary cholangitis

Primary sclerosing cholangitis LF

Secondary biliary cholangitis LF

Viral hepatitis (6% of exam)

Hepatitis A LF

Hepatitis B

Acute hepatitis B LF

Chronic hepatitis B

Hepatitis C

Acute hepatitis C LF

Chronic hepatitis C

Delta hepatitis LF

Hepatitis E LF

Autoimmune hepatitis

Vascular liver disease LF

Nonalcoholic fatty liver disease

Drug-induced liver disease

Pregnancy-related liver disease LF

JANUARY 2018 6
 – High Importance: At least 75% of exam – Medium Importance: No more than 25% – Low Importance: No exam questions
questions will address topics and tasks of exam questions will address topics and will address topics and tasks with
with this designation. tasks with this designation. this designation.

LF – Low Frequency: No more than 17% of exam questions will address topics with this designation, regardless of task or importance.

LIVER
continued… Risk Assessment/
Treatment/ Prognosis/ Pathophysiology/
(22% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

DISEASES AND DISORDERS continued… (18% of exam)

Acute liver failure LF

Neoplasms of the liver

Benign

Malignant

Liver abscess LF

Hepatic manifestations of
systemic disease

Liver transplantation

Indications and complications

Surgical considerations for patients

who have liver disease
Extrahepatic manifestations in
patients who have liver disease

Risk Assessment/
BILIARY TRACT Treatment/ Prognosis/ Pathophysiology/
(10% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (<2% of exam)

Anatomic abnormalities LF

Physiology of the biliary tract LF

SYMPTOMS AND CLINICAL PRESENTATION (<2% of exam)

Obstructive jaundice

Right upper quadrant pain

Hemobilia LF

JANUARY 2018 7
 – High Importance: At least 75% of exam – Medium Importance: No more than 25% – Low Importance: No exam questions
questions will address topics and tasks of exam questions will address topics and will address topics and tasks with
with this designation. tasks with this designation. this designation.

LF – Low Frequency: No more than 17% of exam questions will address topics with this designation, regardless of task or importance.

BILIARY TRACT
continued… Risk Assessment/
Treatment/ Prognosis/ Pathophysiology/
(10% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

DISEASES AND DISORDERS (8% of exam)

Gallstone disease

Gallbladder diseases

Bile duct diseases

Biliary infections

Neoplasms of the biliary tract

Benign LF

Malignant

Biliary motility and functional

LF
disorders

Risk Assessment/
PANCREAS Treatment/ Prognosis/ Pathophysiology/
(11% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (<2% of exam)

Anatomic abnormalities LF

Physiology of the pancreas LF

SYMPTOMS AND CLINICAL PRESENTATION (<2% of exam)

Malabsorption

Duct disruptions

DISEASES AND DISORDERS (8% of exam)

Acute pancreatitis

Chronic pancreatitis

Neoplasms of the pancreas

Benign

Malignant

JANUARY 2018 8
 – High Importance: At least 75% of exam – Medium Importance: No more than 25% – Low Importance: No exam questions
questions will address topics and tasks of exam questions will address topics and will address topics and tasks with
with this designation. tasks with this designation. this designation.

LF – Low Frequency: No more than 17% of exam questions will address topics with this designation, regardless of task or importance.

Risk Assessment/
SMALL INTESTINE Treatment/ Prognosis/ Pathophysiology/
(10% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (2% of exam)

Congenital anomalies LF

Acquired structural anomalies LF

Digestion, absorption, and

malabsorption

Mechanical obstruction and ileus

SYMPTOMS AND CLINICAL PRESENTATION (<2% of exam)

Diarrhea

Acute abdominal pain

Chronic abdominal pain

Bleeding from small intestinal source

Abdominal distention, bloating,

and gas

DISEASES AND DISORDERS (7% of exam)

Small bowel motility and functional

disorders

Small bowel infections

Small bowel injury LF

Immunologic and inflammatory disorders of the gut

Eosinophilic gastroenteritis LF

Crohn’s disease of the small bowel

Complications

Extra-intestinal manifestations

Celiac disease

Neoplasms of the small bowel

Benign LF

Malignant LF

Vascular disorders of the small

bowel
JANUARY 2018 9
 – High Importance: At least 75% of exam – Medium Importance: No more than 25% – Low Importance: No exam questions
questions will address topics and tasks of exam questions will address topics and will address topics and tasks with
with this designation. tasks with this designation. this designation.

LF – Low Frequency: No more than 17% of exam questions will address topics with this designation, regardless of task or importance.

Risk Assessment/
COLON Treatment/ Prognosis/ Pathophysiology/
(20% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (<2% of exam)

Volvulus and intussusception LF

Defecation

SYMPTOMS AND CLINICAL PRESENTATION (<2% of exam)

Constipation

Diarrhea

Fecal incontinence

Lower gastrointestinal bleeding

Abdominal pain

DISEASES AND DISORDERS (17% of exam)

Colorectal motility and functional

disorders

Colorectal infections

Colorectal injury LF

Inflammatory bowel disease

Microscopic colitis

Ulcerative colitis

Crohn’s disease

Diverticular disease

Hemorrhage

Diverticulitis

Appendicitis LF

Neoplasms of the colon and rectum (5% of exam)

Benign

Malignant

JANUARY 2018 10
 – High Importance: At least 75% of exam – Medium Importance: No more than 25% – Low Importance: No exam questions
questions will address topics and tasks of exam questions will address topics and will address topics and tasks with
with this designation. tasks with this designation. this designation.

LF – Low Frequency: No more than 17% of exam questions will address topics with this designation, regardless of task or importance.

COLON
continued… Risk Assessment/
Treatment/ Prognosis/ Pathophysiology/
(20% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science

DISEASES AND DISORDERS continued… (17% of exam)

Vascular disorders of the colon

and rectum

Perianal and anorectal disorders

Post-surgical colorectal conditions LF

JANUARY 2018 11