ABIM Says MOC 10-Year Exam May Be on Its Way Out

September 16, 2015

The American Board of Internal Medicine (ABIM) has announced that it will consider replacing its 10-year maintenance of certification (MOC) exam with shorter, more frequent testing that physicians could take at home or in the office.

The proposal to eliminate the 10-year exam is one of several recommendations issued today by ABIM's "Assessment 2020 Task Force," convened in 2013 to improve its controversial MOC program for internal medicine (IM) physicians and IM subspecialists. ABIM released the task force report less than a week after the American Board of Anesthesiology (ABA) announced that it would replace its 10-year MOC exam with continuous online testing next year.

Many physicians dislike the 10-year MOC exam because of its high-stakes nature. Mess up, and one's job or hospital privileges may be on the line, because many healthcare organizations use board certification to vet their physicians.

Performance on the replacement to the 10-year exam envisioned by the ABIM task force would have career consequences as well.

"The results of the smaller, more frequent lower-stakes assessments would provide insight into performance and accumulate in a high-stakes pass/fail decision," the task force said in its report. "A failure at this point may necessitate taking a longer exam or another form of assessment in order to maintain certification."

Part of the periodic testing would be open-book.

"With All Deliberate Haste"

Richard Baron, MD, ABIM's president and chief executive officer, told Medscape Medical News that the continuous online testing in the works for ABA diplomates "is a good model in concept" for replacing his group's 10-year exam.

"But the execution issues aren't trivial," said Dr Baron. "We'll be monitoring what the ABA does with considerable interest."

The task force recommendations are the latest development in what might be called the MOC Spring, in which physicians across many specialties have lambasted recertification activities — and not just 10-year exams — as clinically irrelevant and financially burdensome. Faced with an especially bitter revolt among its diplomates, ABIM has recently relaxed its MOC program in a number of ways. It has suspended the practice assessment, patient voice, and patient safety module requirements, decried by some as busy work, for 2 years. In addition, ABIM now recognizes most forms of continuing medical education approved by the Accreditation Council for Continuing Medical Education as credit toward training points.

The proposal to replace the 10-year MOC exam quickly garnered praise from the American College of Cardiology (ACC), which represents a major subspecialty in internal medicine.

"The ACC strongly agrees with the report about the need to develop a new, externally validated process for measuring competence to replace the 10-year exam — with all deliberate haste!" the ACC said today in a news release.

Besides Dr Baron, the 19-member ABIM task force included luminaries such as author Abraham Verghese, MD, professor at the Stanford University School of Medicine; Robert Wachter, MD, interim chair of the internal medicine department at the University of California, San Francisco, and the reputed founder of the hospitalist specialty; and Ted Eytan, MD, a director of the Permanente Federation, which represents physicians in the Kaiser Permanente system.

ABIM is one of 24 specialty boards under the umbrella of the American Board of Medical Specialties (ABMS)

Some Recommendations Are Already in Place

The ABIM task force proposed several other changes to recertification. It said that replacing the 10-year exam with continuous testing would likely eliminate the need for the current self-assessment component of its MOC program.

The group's report also called on ABIM to focus on assessing a physician's cognitive and technical skills as they relate to internal medicine and rethink how it assesses other competencies such as communication, teamwork, empathy, and quality improvement. The best approach to these softer skills, the task force said, "is not clear."

Dr Baron said the task force's reasoning explains why ABIM suspended its MOC requirements for quality improvement earlier this year, making them optional instead.

ABIM beat the task force to the punch on another recommendation — to no longer require physicians to get recertified in their basic specialty when they must be certified for their subspecialty. In other words, a physician certified in interventional cardiology would not have to maintain his underlying board certification in cardiovascular disease. ABIM has already introduced that change.

Dr Baron said that ABIM will now mull over the recommendations of the task force, getting input from pertinent medical societies in the process. He did not specify any timetable for possible changes to the MOC program. "It's a continuous, ongoing process," he said.

Asked to put the task force's work in context with widespread criticism of its MOC program, Dr Baron said, "The report and the actions we've taken this year show that it's a different ABIM, and that we're committed to working with the medical community."

"I think that the community wants [MOC] standards to be meaningful and not to involve a lot of busy work. I would say [to critics], 'We're moving in that direction. Keep working with us to make it better.'"

Devil in the Details

One of those critics, cardiologist Paul Teirstein, MD, told Medscape Medical News that the task force recommendations are "all very positive," but the devil will be in the details of what ABIM finally decides. "I don't think we're through reshaping the MOC process."

Dr Teirstein, chief of cardiology at the Scripps Clinic in San Diego, California, and other physicians formed an alternative to the ABMS called the National Board of Physicians and Surgeons (NBPAS) to give their colleagues what they call a more meaningful and less expensive path to recertification. The NBPAS, he said, "has played a role in inspiring these changes" at ABIM. (Disclosure: Eric Topol, MD, editor-in-chief of Medscape, is a member of the National Board of Physicians and Surgeons advisory board, an unpaid position.)

The new board will remain in existence for the foreseeable future, he said.

"Competition is good," said Dr Teirstein. "It keeps people on their toes."

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