ABIM Updates MOC Program With Feedback From Physicians

Ken Terry

June 15, 2015

The American Board of Internal Medicine (ABIM) has introduced a new maintenance of certification (MOC) examination score report and has updated the internal medicine MOC examination blueprint. Both moves represent a continuation of the new direction on MOC that the ABIM announced in February following widespread protests from physicians about its previous approach.

The moves come on the heels of a controversial article in Newsweek that highlighted the pushback on the ABIM's MOC program and called into question some of the finances of the organization.

Beginning with the results of their spring 2015 exams, physicians will receive enhanced score reports with more information about their performance. The reports will be in a new electronic format that includes a visual presentation of the results, more detailed feedback about missed questions, and links to supplemental information.

The updated MOC exam outline is designed "to ensure the exam reflects what internists in practice today are doing and to provide more detailed explanations of topics that may be included in the exam," an ABIM news release said. "This is the first step in the ongoing process of updating the Internal Medicine MOC Exam."

The subspecialty makeup of the questions on the MOC exam has changed only slightly. The most notable changes are a decrease in the number of questions related to hematology and obstetrics/gynecology and an increase in number of questions on nephrology and urology.

The new blueprint also shows the relative amount of emphasis placed on questions related to diagnosis, testing, treatment/care decisions, and other factors.

The MOC exam must be taken every 10 years by all internal medicine generalists and subspecialists who received their initial board certification in 1990 or later. In addition, the MOC requires physicians to earn credits for exercises in lifelong learning and self-assessment, testing, and practice improvement. Before 2014, they could perform that work in the year before their recertification exam. But starting last year, changes in ABIM MOC criteria required doctors to engage in continuous education and self-assessment.

What this meant for ABIM diplomates is that they had to complete at least 10 accredited education modules every 2 years and 100 every 5 years. Physicians who failed to do so faced the threat of having their certification revoked.

"We Got It Wrong"

Facing a revolt from physicians, Richard Baron, MD, ABIM's president and chief executive officer, sent a letter to 14 medical societies on July 28, 2014, promising to revamp the internal medicine board's MOC program. On February 3 of this year, saying we got it wrong," the ABIM announced major changes in the program and said it wanted to work more closely with the internal medicine community.

Among other things, the ABIM said it would suspend the practice assessment, patient voice, and patient safety requirements of the MOC for at least 2 years. As a consequence, no internist will have his or her certification revoked for not completing those requirements. The ABIM also pledged to update the MOC exam to make it "more reflective of what physicians in practice are doing." The changes are to be incorporated beginning this fall. In addition, the ABIM said it would find "new and more flexible ways for internists to demonstrate self-assessment of medical knowledge by recognizing most forms of ACCME-approved Continuing Medical Education."

The news release on the ABIM's latest changes emphasized that both the new score reports and the updated blueprint were created with input from the physician community. For example, the organization said that focus groups of physicians, a survey, and one-on-one interviews were used in the ABIM's "enhanced, user-friendly score report." Likewise, a sample of practicing internists had input into the updated exam blueprint.

Commenting on the initiative, Dr Baron said, "Both initiatives reflect ABIM's efforts to listen to physicians and engage the internal medicine community in the design of ABIM programs."

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