New ABIM MOC assessment addresses past criticisms
After drawing a great deal of criticism from physicians with its previous maintenance of certification program in 2014, ABIM recently created a new MOC assessment option called “Knowledge Check-In.”
The changes to the exam were made in response to the criticisms and aim to offer physicians more choice, relevance and convenience, according to ABIM.
Criticisms of past MOC exam
Following the release of the MOC assessment in 2014, physicians expressed significant concerns.
In January 2015, David A. Cook, MD, MHPE, professor of medicine at Mayo Clinic, and colleagues, published a study in JAMA Internal Medicine that uncovered the barriers associated with MOC. The study found that primary care physicians believed that the assessment was inefficient, not valuable, “unnecessarily complex” and did not support its intended purposes to promote high-quality care and lifelong learning.
Participants reported that they wanted to maintain their clinical competence and professional identity, but were deeply frustrated with the exam. They noted that part II on self-assessment modules and part IV on practice performance projects were particularly irrelevant to practice.
Cook and colleagues proposed that the MOC exam be altered to be more relevant, effective and cohesive, less redundant, integrate activities better aligned with the needs of clinical practice and provide more administrative support to physicians.
Shortly after, in February 2015, ABIM responded by announcing immediate changes to the MOC program.
“ABIM clearly got it wrong,” Richard Baron, MD, president and CEO of ABIM, said in the statement. “We launched programs that weren’t ready and we didn’t deliver an MOC program that physicians found meaningful. We want to change that.”
Changes to MOC
The Knowledge Check-In is not replacing the traditional 10-year MOC exam, Baron told Healio Internal Medicine. Both assessments will be available to physicians, he said.
The new assessment option is more frequent, required every 2 years rather than every 10 years, and can be completed at home, workplace or test center. The new exam is video proctored and open book with access to UpToDate. The traditional MOC exam will also now allow access to UpToDate due to physician feedback, Baron noted. Physicians will have about 3 hours to complete the new assessment. Many will receive performance results immediately and more detailed feedback will be provided shortly after.
In addition, the new exam has “lower consequences” — if a physician does not pass, they will have the opportunity to take it again 2 years later without needing to change their certificate status, according to ABIM.
The new assessment is currently available for internal medicine and nephrology and will be rolled out to other specialties in 2019 and 2020.
“Much of the change is in response to the outcry and dismay,” Baron said.
“The apology letter we sent in 2015 was not just an apology; it set out a framework for what we thought we hadn’t done right and what we thought we needed to change to do better,” he said.
ABIM recognized that it needed broader input from the community of practicing internists and professional societies, according to Baron. ABIM has taken many steps to get that input and has made many changes based on that input, he said.
To ensure that relevant information was on the test, ABIM asked every board-certified doctor in each respective discipline to review part or all of the exam blueprint and provide feedback if they were willing, according to Baron. Based on the feedback, ABIM changed the content and eliminated questions.
“Every important change we make is in dialogue with the community,” Baron said. “We heard that people didn’t want a once every 10 years, high stakes, consequential exam, they wanted more frequent, less burdensome assessments that were not as consequential and the design of this Knowledge Check-In is exactly that.”
“We’re offering an exam that is more relevant, that looks more like what people see in practice, and that’s because we changed it by talking to thousands of doctors in practice about what they see,” he added.
“We hope that doctors will experience a program that they don’t see as burdensome and they feel is higher value,” Baron said.
The early feedback has been quite positive, he said.
ABIM routinely asks people at the end of the exam if they think it was a fair assessment of their knowledge, according to Baron. So far, the Knowledge Check-In assessment has gotten its highest ratings ever, which most likely has a lot to do with the blueprint review and being able to use UpToDate, which is a resource many physicians use in practice, he said. Physicians have reported that they like being able to take the exam at home or their office, he said.
There were a few technical challenges encountered that made a small percentage of test takers unhappy, but in general, that’s the minority of people, Baron said.
“We’re close to 7,000 internists who have taken the assessment this year and most have reported positive experiences,” he said.
Value of MOC
Practicing medicine has changed drastically in the past 30 years, according to Baron.
“So, the value of MOC is having a credential that tells you, your patients and your colleagues that you have stayed current in the field,” he said. “It’s a way to show that you have a publicly distinguishable and recognizable credential.”
Over the course of the career of a physician, there is an ongoing need to demonstrate currency in the field; but not everybody does and there needs to be a way to identify those who have and those who have not, he said.
“I think most doctors deeply worry about if they are good enough, if they have stayed current enough and if they are giving the right advice to their patients,” Baron said.
“MOC supports comprehensive learning and it gives people feedback on what they actually learned and whether they’re on top of their game,” he said.
ABIM data suggests that physicians who are board-certified provide better patient care. For example, patients treated by a board-certified internist are 19% less likely to die than those treated by a non-certified physician, according to ABIM. Additionally, compared with non-certified physicians, those who are board certified are five times less likely to experience state medical licensure disciplinary actions, 34% more likely to adhere to mammography screenings and 27% more likely to adhere to colon cancer screenings.
“Most important changes to MOC are related to being much more connected to the community, being much more in dialogue with the community and being much more in touch with the community,” Baron said. “We are focused on the idea of delivering value by creating a credential that helps people know who’s staying current and who’s not. That’s now a structural property of what we do in a way that it wasn’t before.” – by Alaina Tedesco
Disclosure: Baron is the president and CEO of ABIM.