Alternative to 10-Year MOC Exam Coming in 2019

Marcia Frellick

October 10, 2018

NEW ORLEANS — An alternative to the widely criticized 10-year maintenance of certification (MOC) exam will be available in a few months, family physicians heard Tuesday here at the American Academy of Family Physicians (AAFP) 2018 Congress of Delegates.

Surveys have shown that the overwhelming preference for ongoing certification is longitudinal assessment, said Jerry Kruse, MD, who is chair of the board of directors for the American Board of Family Medicine (ABFM).

"It is the intent of the ABFM to launch this longitudinal assessment pilot in 2019 as an alternative to the 10-year examination," Kruse said to strong applause.

"All family physicians who are scheduled to take the exam in 2019 will be eligible for the pilot," he reported.

Those who choose to participate in the pilot will receive 25 questions every 3 months that can be answered on any computer or tablet at any time. In all, 300 questions will be delivered over a minimum of 3 years and a maximum 4 years. The test is open book, and participants will have 5 minutes to answer each question.

After a question is answered, feedback is immediate. If the wrong answer was selected, the correct answer and supporting references will be provided.

"Clinical references can be used during the assessment, much like you access information in your practice," Kruse said. "A major advantage is that no time will be taken out of your practice for travel for prep courses or testing centers."

No Additional Payment

When Kruse reported that "there will be no additional payment required to participate in this assessment," he got another big round of applause.

That is a big plus for Kevin Bernstein, MD, an alternate delegate for the faction of new physicians.

At a previous meeting, Bernstein coauthored a resolution asking to put an end to the MOC exam being the only requirement in the 10-year recertification process.

On Monday, during reference committee testimony, he addressed the ABFM members at the meeting, saying, "I hope you're able to hear our testimony because we are not very happy with your process."

The current test fees on top of the membership fees are especially onerous for young physicians coming out of residency deep in debt, he told Medscape Medical News.

"If we decide to go forward with this pilot project, we won't have to take the high-stakes exam at the end of the 10-year mark," Bernstein pointed out.

A resolution had been proposed during a reference committee that asked the AAFP commit to developing its own AAFP Board Certification in Family Medicine by 2020, but the resolution was not adopted by the Congress of Delegates.

Resolution Asked AAFP to Develop Its Own Certification

People cited several objections, including the timeline being too short, the prohibitive cost of developing a separate certification, and skepticism that a separate certification would be accepted by patients, employers, and payers.

John Meigs, MD, AAFP board chair, spoke out strongly against the resolution during the reference committee testimony.

"It would be excessively expensive and the timeline is totally impractical. Forming a board just to say you have a board that has no meaning and no standing and doesn't get you anywhere — Lord, have mercy — why?"

The pilot proposed on Tuesday is one answer to what members have been calling for, he told Medscape Medical News.

"We asked ABFM to move away from the high-stakes exam. We wanted them to make the process more meaningful, more relevant, and less of a hassle, and we've seen them take a step in that direction," he said.

"Welcome Development"

The new proposal is "a welcome development," said Clif Knight, MD, senior vice president for education at AAFP, adding that it addresses many concerns members have had.

It offers relief from a full-day exam, which requires travel and time off work. And questions will address the full spectrum of family medicine and are case-based and relevant, he told Medscape Medical News.

"The ABFM has listened to the concerns of the AAFP when we said, 'give people options'," Knight said. "People want something that feels more relevant to the way they practice medicine. I'm sure this will not be perfect but it's a step in the right direction."

The 10-year test might still appeal to some members, but the option of quarterly questions will be appreciated by others.

Bernstein said he has a few years to decide which will be the best option for him.

Kruse is board chair of ABFM. Knight is senior vice president for education at AAFP. Meigs is AAFP board chair. Bernstein has disclosed no relevant financial relationships.

American Academy of Family Physicians (AAFP) 2018 Congress of Delegates. Presented October 9, 2018.

Follow Medscape on Twitter @Medscape and Marcia Frellick @mfrellick

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