Changes Coming to MOC: Will Physicians Get Relief?

Leigh Page


June 05, 2018

In This Article

Offering Help for the Exam

The ABIM publishes "blueprints"—a list of topics that will be on the next exam and what percentage of questions they will represent, so that physicians can focus their studying. "Blueprints show content specifications for each exam and include an outline of the content areas and their approximate percentages for a typical exam," the ABIM states.[28]

The ob/gyn,[29] surgery,[30] orthopedic surgery,[31] and dermatology[32] boards also offer exam blueprints. However, Hingle reports that the ABIM blueprint, at least, is not that useful. "The exam blueprint is not very comprehensive, so it's hard to pinpoint things that you should be studying," she says.

Some boards also allow use of reference material for the new online exams. While the ABIM's Knowledge Check-In allows only one outside resource (UpToDate), the new online test to be offered by allergy and immunology and surgery boards do not limit open-book resources.[18,33]

Reference materials "simulate real-life application of knowledge and decision-making," according to the recent statement by the ABMS and its boards.[25] However, all of the boards strictly prohibit consulting with colleagues during the test.

For the online tests, many boards only allow computers that have video cameras, so that they can determine whether the physician is consulting others or is using unauthorized reference materials. For example, the ABD offers the following instructions for starting the remote version of its exam: "Perform a scan of the room with the webcam to demonstrate compliance with exam guidelines (ie, no notes, text books, electronic devices)."[9]

Focusing on Subspecialty Knowledge

A central concern of MOC critics is that the old exams and even the shorter online tests do not adequately portray the knowledge that each physician actually needs to know for his or her own particular practice.

Asked about the MOCA Minute, Sibert says: "My impression is that much of it is irrelevant for specialists [within anesthesiology], who end up having to answer lots of questions about other specialty areas that do not pertain to them. For community physicians, it seems to involve far too much academic detail and not enough good general information."

In a survey of physicians published in 2016, only 24% agreed that MOC was relevant to their patients. Meanwhile, only 15% felt that MOC exercises are worth the time and effort, and 81% believed that they are a burden.[34]

Things are changing somewhat. Until 2015, the ABIM exam forced subspecialists to know a great deal about general internal medicine. Milton J. Guiberteau, MD, president of the ABIM's sister board for radiologists, noted this in a July 2015 speech that sought to distance his board from doctors' anger with the ABIM's 2014 changes.[35]

In the ABIM exam, "regardless of what your specialty was, you took an examination over the entire spectrum of internal medicine," he noted. That same month, the ABIM had just ended that requirement, announcing that subspecialists would no longer need to maintain underlying certifications to stay certified, including taking the general internal medicine exam.[36]

Some other boards allow subspecialists to choose a great deal of subspecialty content for the exam—and presumably for the shorter online assessments:

  • In the current exam, pathologists can choose from among 90 exam modules covering anatomic and clinical pathology and most subspecialties.[37]

  • In the new assessment, general surgeons will be able to choose a practice-related component, but "the initial divisions will of necessity be fairly broad," the ABS announced in July 2017.[38]

  • In the current dermatology exam, examinees must take the general dermatology module, which consists of 100 clinical images, and then they can choose a 50-item subspecialty module.[39]

  • The current exam for plastic surgeons is 25% about core principles and 75% about subspecialty content.[39]


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