Self-Assessment, Lifelong Learning, &
Assessment of Performance in Practice:
Maintenance of Certification for
Family Physicians Parts II &IV
David Price, MD
Colorado Permanente Medical Group
Associate Professor Family Medicine
UCSHC
Chair-elect, American Board of Family
Medicine
MedBiquitous April 2007
MOC
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Response of ABMS & member boards to
quality concerns & gaps
Multiple stakeholders (patients, FSMB, AMA,
ACCME, physicians, etc.)
Components of MOC (MC-FP)
Professionalism
Periodic self-assessment (SAM*)
I.
II.
•
•
•
Knowledge assessments (KA*)
Clinical Simulations (ClinSim*)
CME
Cognitive expertise (Examination)
Practice-based learning & improvement
III.
IV.
•
•
•
•
PPM
MIMM
Pt-Clinician Communication
Pt Safety module
Extend Certification From
7 to 7+3 Years
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
Old: 6 SAMs + 1 PPM then exam year 7
NOW: Diplomates engaged/remaining in MCFP process can extend certificate to 10
years by completing MC-FP requirements in
3 blocks:


2 SAMs + 1 PPM per 3 year block x 3 blocks
with exam in 10th year.
Part II (SAMs + Simulations)
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2004: DM, HTN
2005: CAD, Asthma
2006: Depression, Heart Failure
2007: Well child care, Pain management
2008: Health behavior change, Maternity care
Eventual choice from about 20 modules
SAM: Diabetes Mellitus
Diagnosis
5 quest.
Recognition/mgmnt. macrovasc. Compl.
10 quest.
Recognition/mgmnt. microvasc. Compl.
10 quest.
Non-pharmacologic mgmnt
5 quest.
Pharmacologic mgmnt
15 quest.
DKA/HONK mgmnt
5 quest.
Clin. Impl. Insulin resistance
5 quest.
Prevention
5 quest.
Percent
Hypertension SAM/ClinSim Ratings as of April 1, 2005
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
N = 1744
Means:
Relevance 5.54
Currency
5.66
Usefulness 5.31
Overall
5.18
6
5
4
3
2
Rating (high--> low)
Relevance
Currency
Usefulness
Overall
1
ABFM Self-Assessment Modules: Completion Time
Diabetes
800
Frequency
600
400
200
0
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16
FinishHours
Changes Resulting from Diplomate
Input
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Questions printable for initial completion off
line (“pre-test”)
Only incorrectly answered questions appear
upon completion
On-line full text references for questions
Direct link to references from questions
CME Process vs. QI cycle
Price D. Continuing medical education, quality improvement, and transfer
of practice. Medical Teacher 2005;27(3): 259-268.
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Needs assessment

Objectives
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Implementation

Evaluation

Follow-up

Plan

Do

Study

Act
Part IV

Patient-based, physician controlled
improvement model (HTN, DM, CAD, asthma,
depression, HF)
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6 or more quality indicators per condition
Practice audit 10 charts/patients
Feedback vs. peers & benchmarks
Select area(s) for improvement
Develop QI plan (from a “QI wizard”)
Re-audit (PDSA) 10 charts/patients
I hope this has been an eye
opening experience