By Oren Fix, MD, MSc, FAASLD, Chair, Maintenance of Certification (MOC) Committee
The MOC space is evolving so rapidly it’s hard to keep up with all the new announcements coming from the American Board of Internal Medicine (ABIM). As Chair of AASLD’s MOC Committee, I want to keep our members abreast of these changes and try to help AASLD react and respond in ways that best serve its members and the hepatology community. Included at the top of this article are some highlights with more detailed information below.
Here’s what we’ve heard this year from ABIM:
- March: ABIM announced a new alternative to the traditional 10-year exam called the 2-year “knowledge check-in”. (ABIM Blog Post – Mar 2017)
- June: ABIM shared their plans on sun-setting their annual Medical Knowledge Modules in 2018.
- September: ABIM provided more details about the knowledge check-in. (ABIM Blog Post – Sep 2017)
- Coming Soon: ABIM will announce its plans for the MOC requirement to complete part IV practice assessment activities that is currently suspended until December 31, 2018
Reactions and responses to these changes have been varied across groups involved in MOC:
- ABIM is moving forward with these changes and has chosen to work with a selected few societies – American College of Physicians (ACP), American College of Cardiology (ACC), American Society of Clinical Oncology (ASCO) – to develop new collaborative MOC pathways (Pilot Announcement – Sep 2017)
- AASLD and other specialty societies continue to pressure ABIM to address our concerns with their MOC program. AASLD also continues to offer an increasing number of activities for MOC points, with costs covered through AASLD membership or meeting registrations.
- More and more state legislatures are responding to the backlash from the community by passing legislation to prevent discrimination against physicians based on their MOC status.
Knowledge Check-In: As we shared with the membership in May (AASLD May eNews) this alternative assessment pathway will be available to diplomates certified in Internal Medicine and Nephrology in 2018, and will be available for GI in 2019 and Transplant Hepatology in 2020.
These will be shorter assessments (2-3 hours) that can be taken on a home or office computer. The total number of test questions is currently not known. ABIM recently announced that these shorter assessments would be timed and open-book exams. Subsequently they announced that the only outside resource for the 2018 knowledge check-ins will be UpToDate® (examinees will not need a subscription to access UpToDate® during the assessment). The exam will only be available at designated times. It will not be live-proctored, but participants will be recorded via webcam. ABIM has indicated that this video will only be viewed if there is evidence of a problem that needs to be investigated. Results will be available almost immediately and feedback in the form of ABIM’s new enhanced score report will be sent after about 3 weeks to help with self-assessment.
ABIM also announced that certification will not be suspended for failing one of the 2-year knowledge check-ins. Diplomates will no longer be able to use the 2-year check-in option if they fail 2 consecutive times and they will have to take the traditional 10-year “long-form” exam. Diplomates will only lose certification if they fail a 10-year exam, which is considered more psychometrically rigorous. ABIM has indicated that the fees for the 2-year and traditional 10-year pathway will be the same and that diplomates may transition from one to the other. Similar to the 10-year exam, diplomates will earn 20 MOC points for each exam attempt, which fulfills the requirement to complete at least one MOC activity every 2 years and will help toward the requirement to earn 100 points every 5 years. There are many questions that remain about this new assessment pathway, which we hope will be answered by the time the pathway is offered for GI and Transplant Hepatology.
Medical Knowledge Modules: ABIM will no longer offer their annual Medical Knowledge Modules (except Internal Medicine and Hospital Medicine), which follows in the footsteps of the Practice Improvement Modules (PIMs). This means that ABIM will offer very few activities for Part 2 (Medical Knowledge) MOC points other than their exams. ABIM is relying on the increasing availability of Part 2 Medical Knowledge activities that are being produced by specialty societies like AASLD, facilitated by ABIM’s new partnership with the ACCME.
Society pilots: ACP, ACC, and ASCO have each signed a Memorandum of Understanding with ABIM to create new collaborative maintenance pathways. The details of these pilot programs are still unclear, although we know that ACP’s pilot will likely involve their Medical Knowledge Self-Assessment Program (MKSAP). It is not known when these pilot programs will be available or whether ABIM will consider other pilots, but these collaborations suggest that ABIM intends to work with at least some societies to improve MOC.
State legislation: Texas recently joined a growing list of states that have passed “anti-MOC” legislation that expressly prevents hospitals and other health facilities, managed care plans, and state licensing boards from discriminating against physicians based on their MOC status. Some state medical societies have advocated for this in part because many believe the certification boards have been too slow to respond to criticism and change, or are perceived as unwilling to listen to the community. ABIM sees this as a dangerous trend because allowing state governments to arbitrate certification and MOC may lead physicians to lose our ability to self-regulate our profession. If these laws stimulate conversation to increase the pace of MOC reform, perhaps some positive change can be achieved.
More to come: Expect announcements from ABIM before the end of the year about changes to its fee structure and changes to Part IV (practice assessment) requirements. ABIM has indicated the fees for the 2-year knowledge check-in pathway and the traditional 10-year exam pathway will be equivalent. Although Part IV requirements are on hold for now, ABIM continues to recognize and reward practice assessment activities through its Approved Quality Improvement (AQI) program, Portfolio Program, and by granting credit to ACGME-accredited training program directors. It is unclear if the Part IV requirement will return or in what form but ABIM will make an announcement before the end of 2017 about changes that will be implemented in 2019.
What is AASLD doing about all of this? AASLD remains committed to keeping its members informed about changes to MOC and our response to them. We continue to advocate for MOC reform in our discussions with ABIM (Liaison Committee on Certification and Recertification, Community Engagement Days) and with other specialty societies. We continue to expand our MOC activities and we are offering most of these activities as a benefit of membership at no additional charge, including many live events that are offered online on LiverLearning . At The Liver Meeting®, we are offering over 27 MOC points (see Table), including MOC points for ABIM and American Board of Pediatrics (ABP). While some activities require participants to answer multiple choice questions with immediate feedback, in many cases they can earn MOC points by answering a simple question with a couple of sentences. For more information about MOC and AASLD’s MOC program, please join us at the MOC Update at The Liver Meeting® on Sunday, October 22, from 1:15 – 2:45 PM in Room 150 of the Convention Center. You can also visit our website at https://www.aasld.org/moc or contact Katie Duggan, AASLD’s Director of Training and MOC, at firstname.lastname@example.org.