The American Board of Internal Medicine’s current Maintenance of Certification program does not meet the educational needs of rheumatologists and should be modified to include more relevant professional development requirements, according to an Aug. 26 announcement by the American College of Rheumatology.
“Rheumatologists without a doubt believe in the value of continuing medical education,” Dr. E. William St.Clair , ACR president, said in a statement. “However, our members strongly feel the ABIM MOC [American Board of Internal Medicine Maintenance of Certification] program not only fails to appropriately assess their competence but lacks evidence that patients are benefiting from their involvement with it.”
The ACR released a position statement that includes several ways in which ABIM should change its MOC process, including dropping its secure, closed-book MOC examination, and permanently removing the practice assessment, patient voice, and patient safety requirements as part of its recertification process.
In an interview, Dr. Richard J. Baron, ABIM president, said his association welcomes the ideas presented by the ACR and that as with other feedback from medical societies, ABIM will review the suggestions for possible implementation.
“We have invited all of the internal medicine societies to cocreate the MOC program with us,” Dr. Baron said. “The American College of Rheumatology took that invitation seriously. They created a physician paper to constructively help inform the development of future MOC programs. We are absolutely prepared to engage in conversations with them based on these kinds of efforts.”
As part of its statement, the college said the practice assessment, patient voice, and patient safety requirements should not be reinstated because they are redundant with existing requirements that measure and report quality of care. The secure, closed-book exam is not an appropriate means of assessing clinical knowledge or decision-making for the purpose of recertification, according to the position statement. The ACR also wants ABIM to eliminate its MOC medical knowledge points, saying that continuing medical education (CME) activities already are highly regulated, and that another layer of mandated educational activities is not necessary. Instead, physicians should have the autonomy to identify and access appropriate CME resources.
The college calls for the cost and scope of the MOC program to be reduced and for an independent review to be conducted. The external review should examine the performance and impact of the MOC program, including policies, procedures, organizational structure and governance, according to the position paper.
“We are encouraged by the recent changes the ABIM has made and hope the ABIM will strongly take into consideration the position of the college and our members as it continues to reform the MOC program,” said Dr. Joel Block, ACR Committee on Education chair. “We share the same goal of ensuring our patients receive the highest quality of care available, but we have identified numerous areas where the current MOC process fails in this aim while substantially adding to physicians’ administrative and cost burdens. It is our desire to see barriers that prevent our members from pursuing meaningful educational activities in order to meet MOC requirements removed.”
ABIM plans to meet with medical societies through subspecialty boards over the course of the fall and work through ideas and proposals, Dr. Baron said.
“Part of where we started was trying to find common ground with the community, and that common ground is that all of us in the internal medicine community believe that physicians should stay current in knowledge and practice over course of their careers,” Dr. Baron said in an interview. “The role that many members of the community see ABIM playing is designing a program that speaks to that. How the program does those things is a matter of ongoing implementation and change.”
ABIM has made a growing number of changes to its MOC program following a February announcement by the association apologizing to physicians for a program that “clearly got it wrong.” At the time, ABIM pledged to make the program more consistent with physicians’ practice and values. Among the immediate changes are updates to its internal medicine exam; suspension of the practice assessment, patient voice, and patient safety requirements for at least 2 years; and setting MOC enrollment fees at or below 2014 levels through at least 2017.
In August, ABIM announced a partnership with the Accreditation Council for Continuing Medical Education that aims to unify continuing education activities with MOC requirements and expand doctors’ options for MOC credit. On Aug. 4, ABIM announced that physicians who do not enroll in its MOC program will no longer automatically lose their board certification status.
In July, ABIM announced that no disciplines within its MOC program will require underlying certification and that all ABIM diplomates can choose the certifications they wish to maintain. The policy goes into effect Jan. 1, 2016. In early June, ABIM rolled out changes to its exam outline and score report. Starting with spring 2015 exams, physicians will receive enhanced score reports with more performance details, according to ABIM.
On Twitter @legal_med
