SAN DIEGO (FRONTLINE MEDICAL NEWS) – The way the president of the American Board of Internal Medicine, Richard J. Baron, MD, sees it, maintenance of certification is more important than ever, because trust in the medical profession “is under assault right now in all kinds of ways.”

So, to help “bring clarity to uncertainty,” ABIM is continuing its makeover of the maintenance of certification (MOC) process. Beginning in 2018, an open-book option to test every 2 years will be available for physicians who are certified in internal medicine and for those in the subspecialty of nephrology.

Both the 10-year long-form assessment and the shorter 2-year assessment options will be open book, “meaning physicians will have access to an online reference while they’re taking the exam,” said Yul D. Ejnes, MD, who is a member of ABIM’s board of directors and serves on the ABIM’s internal medicine specialty board.

Similar maintenance of certification changes are scheduled to be rolled out to other medical specialties by 2020.

Known as the “Knowledge Check-In,” the 2-year assessment is a shorter, “lower stakes” option that can be taken at home, in an office, or at a testing facility. The check-ins will be scheduled 4-6 times per year, with 10-year exams remaining available twice per year. The open-book 2-year assessments will be about 3 hours in length.

“It’s a more continuous way of learning and assessing, because the way we’ll do feedback is going to change,” explained Dr. Ejnes, who practices in Cranston, R.I. “Specifically, you’ll know right away whether you were successful or not with the assessment, as opposed to having to wait a couple of months, which happens with the 10-year assessment. Then you’ll get more feedback later helping to identify areas where you may be a little weaker and need to work out things.”

In general, physicians will need to either take the 2-year assessments or pass the 10-year assessment within 10 years of their last pass of the 10-year exam. Those who fail two successive 2-year assessments will have to take the 10-year exam. However, unsuccessful performance on the 2-year assessment in 2018 will not have a negative impact on certification or MOC participation status.

“It won’t count as one of the two opportunities you have before you have to go to the 10-year exam,” Dr. Ejnes said. “It allows people to try it out and lets us learn from what happens and do whatever we need to do to make things better.”

Why a 2-year period instead of a 5-year option, for example? A shorter time frame will allow the ABIM to move to a more modular approach to test material, Dr. Ejnes explained. For now, the 2-year assessments will be breadth-of-discipline exams.

Physicians whose certification expires in 2017 will need to take the 10-year exam – as Dr. Ejnes noted he himself was forced to do. “You cannot wait until 2018,” he cautioned. “That’s important, because if you let your certification lapse, you can’t enter the certification pathway. The prerequisite is that you need to be in good standing with your certification.”

The open-book Knowledge Check-Ins and 10-year assessments are slated to expand to eight subspecialties in 2019 and nine more in 2020.

Linking MOC and trust

Speaking at the annual meeting of the American College of Physicians, Dr. Baron said that false and misleading information circulated widely on Facebook and other social media channels runs the gamut of health issues, from falsified studies about purported links between vaccines and autism and public health scares on impostor websites, to stories of miracle cures for any number of ailments.

“It’s not just vaccines people are questioning,” said Dr. Baron, ABIM’s president and CEO. “There are erosions of trust in government, and there’s the tenacity and power of wildly inaccurate information. You will be dealing with patients who tenaciously believe things that you know not to be true. You will need to find ways to build trust, credibility, and relationships based on their trusting that what you’re saying is really in their interest.”

U.S. physicians aren’t secure in the shaky trust landscape. In fact, globally, the United States ranks 24th in public trust level of physicians by country ( N. Eng. J. Med. 2014 Oct 23;371[17]:1570-2 ).

“The confidence in the medical system today is lower than the confidence in police or in small business,” Dr. Baron said. “That’s [the view] people are bringing into your offices every day. I don’t think we can assume that deference and trust are given to doctors, that the privileged role that society affords us is something that we’re going to have forever. We all have to think how trust is built in the new world.”

Will patients value MOC?

During a question and answer session at the ACP session, Anne Cummings, MD, an internist who practices in Greenbrae, Calif., asked the ABIM for support in educating the general public about what it means to be treated by a board-certified physician.

“I had a naturopath tell me the other day that she had the same training as I had,” Dr. Cummings said. “I was floored, but I think that patients don’t know the difference [between board-certified and not board-certified].”

Dr. Baron agreed ABIM needs to do more to promote the value of certification among patients. But he also called on board-certified physicians to deliver the value message directly to their own patients.

Other attendees recommended that ABIM expand the number of ways physicians can earn MOC points, and they expressed concern about the time MOC takes away from their daily practice.

For regular updates on the MOC process, physicians can subscribe to the ABIM’s blog at .


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