Rebecca L. Johnson, MD
Chair, Pathology &
Clinical Labs
Berkshire Health Systems
President, American Board of
Pathology
MOC
MAINTENANCE OF
CERTIFICATION WHY SHOULD I CARE?
History of Board Certification

1908 Derrick Vail, MD

Presidential address to the American Academy
of Ophthalmology & Otolaryngology

“I hope to see the time….let him then be
permitted and licensed to practice
ophthalmology.”
American Board Of Ophthalmology
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Am. Ophthalmologic Society, AMA, Academy
of Ophthalmology
1915—Defined requirements
1917—ABO established
Early Boards
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1924—Am Board of Otolaryngology
1930—Am Board of Obstetrics & Gynecology
1932—Am Board of Derm & Syphilology
1933—Am Board of Pediatrics
1934—Psychiatry & Neurology, Radiology, Orthopedic
Surgery
1935—Colon & Rectal Surgery, Urology
1936—Internal Medicine, PATHOLOGY
Advisory Board
For Medical Specialties




Est. 1933
Uniformity in MD certification
Increase public awareness
Education, training, and certification
Advisory Board
For Medical Specialties
 Four
first specialty boards
 AHA, AAMC, FSMB, AMA Council
on Med Ed & Hospitals, NBME
 1970 - American Board of Medical
Specialties (ABMS)
ABMS Purpose



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Discuss common issues
Advise Boards
Coordinate work
Jurisdiction over policies as delegated
Autonomy of any Board
Stimulate improvements in med ed
ABMS

24 Boards
37 Primary specialties
 94 Subspecialties


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2005 ~89% licensed US MDs
Evanston, IL
Kevin Weiss, MD, EVP
www.abms.org
ABMS MISSION

Improve quality of medical care


Professional and educational standards for
certification
Assurance to the public

Certification has meaning and required components
ABMS & Member Boards

Assess

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Education, Training, Licensure, Ethical and
professional requirements
Initial examination
Construction-fair, objective
 Psychometrically reliable and valid
 Assess knowledge & clinical skills

Limits of Board Certification


Assesses only medical knowledge
Snapshot
SOLUTION?
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Recertification
Time limited certification
Maintenance of Certification (MOC)
Evolution from Certification to MOC
1936
1969
2006
Unlimited Certification
Time-Limited
Re-Certification
MOC
2016
ABMS
 1993
Member Boards agree to
Recertification
 1997/98
ABPath Voluntary
Recertification
1998 ABMS
Task Force on Competency

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Mission statement—Diplomates are competent
Define competence
Research and assessment, validation
Template to assess competence
Peer review of certification
Collaborative methods of assessment
GOALS
MOC Relevant
•Accountability for competence
•Accountability for practice quality
•Reshape Continuing Medical Education
MOC is Essential; Tied to:
•Hospital Credentialing
•Maintenance of Licensure
•Pay for Performance
Three Trends Make MOC Relevant

Public wants accountability for performance



Purchaser decision about quality
Quality can be measured

Patient’s perceptions and health status

Guideline adherence and achieving outcomes
Quality can be improved

Health care results from system

Change system processes improves care
Relevance of MOC For A Composite
Measure of Physician Quality

Customers
Healthcare purchasers & patients
 Health plans, medical staffs, group practices


Competitors
National Committee for Quality Assessment
 Center for Medicare and Medicaid Services
 Doctor Quality web sites


Collaborators
JCAHO
 State Medical Boards/FSMB

Changing View of Professionalism
Autonomy
Collaboration
Authority
Evidence
Assertion
Measurement
Control
Transparency
Accountability

Develop evidence of achieving best
results for patient care

Communicate results regularly and
widely to those to whom
accountability is owed
Profession
Public
ABMS & ACGME
Lifetime Competencies

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MEDICAL KNOWLEDGE
PATIENT CARE
INTERPERSONAL & COMMUNICATION
SKILLS
PROFESSIONALISM
PRACTICE BASED LEARNING &
IMPROVEMENT
SYSTEMS BASED PRACTICE
MOC – A Composite Measure of
Competence and Quality
Safe
Timely
Efficient
Effective
Equitable
Patient Centered
Competencies
IOM Quality
Aims
Evolution of MOC
1936--Certification
2006 - Maintenance of Certification
Training

Certification after training
 Competence/Practice

Milestone evidence of competence
 Examination
I.
Professional standing
II.
Lifelong learning & selfassessment
 CME
III.
Cognitive expertise
 License & privileges
IV.
Practice performance &
improvement
1998 Voluntary Recertification
 Examination (optional)

Can apply to all certificates

Single credential
o
Board Certification
o
Maintenance of License
o
Hospital Privileges
o
Public accountability
American Board of Pathology


1936 Michigan
Primary Certification


AP/CP, AP, CP
Subspecialty certification
10
 ACGME approved fellowship


Change in training requirements
AMERICAN BOARD OF
PATHOLOGY

PRIMARY CERTIFICATION
ANATOMIC & CLINICAL PATHOLOGY
 ANATOMIC PATHOLOGY
 CLINICAL PATHOLOGY

AMERICAN BOARD OF
PATHOLOGY- SUBSPECIALTY
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Blood Banking/Transfusion Medicine
Chemical Pathology
Cytopathology
Dermatopathology*
Forensic Pathology
Hematology
Medical Microbiology
Molecular Genetic Pathology*
Neuropathology
Pediatric Pathology
ABP Cooperating Societies

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ACLPS
ADASP
AMA Pathology Section Council
APC
ASCP
ASIP
CAP
USCAP
Maintenance of Certification

ABMS initiative

All 24 specialty boards

2006 -Time-limited (10 year) primary and
subspecialty certificates

Participation in MOC process required

Completed within 8-10 years
ABMS Boards
Recertification
1970
1976
1980
1985
1986
2006
Family Medicine
Surgery
Thoracic Surgery
Emergency Medicine
Urology
OB/GYN
Orthopedic Surgery
PATHOLOGY
7
10
10
10
10
6
10
10
MOC Components
I.
II.
III.
IV.
Professional Standing
Lifelong Learning & SelfAssessment
Cognitive Expertise (the EXAM!)
Evaluation of Performance in
Practice
Part I
Professional Standing

Maintenance of a full and unrestricted license in at least
one U.S. jurisdiction, territory, or Canada

Documentation of medical staff membership and
privileges or, if not applicable, scope of practice

Documentation of licensure and medical staff
privileges at 4th and 8th year
Part II
Life Long Learning- Self-Assessment

70 Category 1 CME credits / 2 year cycle

20 CME credits / 2 yr cycle must be SAMs

80% CME related to individual’s practice

Updated electronic record of activities every 2 years

A fellowship fulfills Part II requirements for 2 year
period

Incomplete fellowships prorated
Part II
Life Long Learning and Self-Assessment
 Content
specifications
 Important
advancements, key concepts
 Basis for CME and self-assessment
 Prep for MOC exam.
 Direct MOC test question development
 Practical “need to know” information,
used in daily practice, required for
competence
 Cover all disciplines of pathology
Part II
Life Long Learning-Self-Assessment



AP and CP Content Committees’ “Content
Outlines” on line, updated annually
Fundamental information for daily practice;
important, validated new knowledge
Outlines are not templates for exam or
endorsements of authors
Self-Assessment Modules (SAMs)
 Elements of SAMs
Educational product
 Self-administered exam
 Minimum performance level
 Feedback

 SAM requirement for 2006-09 period waived
because of insufficient offerings
 Certificates issued by societies should reflect regular
CME versus CME / SAM
Part III--Cognitive Expertise
Examination is mandatory
 “Secure” and closed book
 At least once per year
 Taken 8-10 years after initial certification
 Potential 3 year period of qualification

Part III - Cognitive Expertise


Modular exams related to practice
Exams will include:
Fundamental knowledge
 Current practice-related knowledge
 Emphasis on information new to field
 Practice environment knowledge

Part III
Cognitive Expertise

AP/CP certified individuals may chose to
maintain their certification in AP/CP, AP
only or CP only

Individuals with subspecialty certification
may choose to maintain only their
subspecialty certification
Part III
Cognitive Expertise
MOC exam:

“tailor” exam to practice by selecting modules.

Menu of multiple modules

At least one general module of AP or CP must
be selected by AP/CP examinees
Part III - Cognitive Expertise
MOC EXAM

6 modules of 25 questions (150 total questions)

80% practical (virtual microscopy, case-based
questions etc); 20% written

Modules graded as one exam
AP/CP MOC Exam
Option 1
+
Option 2
+
Option 3
+
+ 4 add. =
total
6
+ 3 add. =
total
6
+ 3 add. = 6
total
CP
General module
AP
Specialty module
AP only MOC Exam
CP only MOC Exam
+
or
+
or
or
or
or
or
or
or
or
or
6 total
3
max
6 total
CP
AP
General module
Specialty module
Modules
Clinical Pathology
General CP I, II, III, IV
Hematology I, II
Blood Bank I, II
Immunopathology
Blood Bank-Coagulation
Microbiology I, II
Coagulation
Chemistry I, II
Modules
Anatomic Pathology
Gen AP I,II
Breast
Gen Surg Path I,II
Cardiovascular
General Cytology I, II
Dermatology I, II
Cytology, Gyn
Endocrine
Cytology, Non Gyn
GI-Liver-Biliary
Bone-Soft Tissue
Autopsy
Revised 11/08
Modules
Revised 11/08
Anatomic Pathology cont’d
Genitourinary
Pediatric Pathology
Gynecologic
Pulmonary/Mediastinal
Head-Neck
Transplant pathology
Medical Renal
Forensic Pathology
Neuropathology
Common Modules*
Revised 11/08
Anatomic and Clinical Pathology
General Hemepath I
(Lymph node-Spleen)
Flow Cytometry
General Hemepath II
(Bone Marrow)
Molecular Pathology
Molecular-Cytogenetics
Lab Man / Informatics
* May be used to fulfill AP or CP specialty
modules
Part III—Exam & MOC Myths



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High stakes—Low failure rate
Irrelevant—Modular
Not useful—Improves MK, Pt. Care
Time consuming—Payoff- meet pt and
regulatory expectations for quality,
accountability, self-regulation
Part IV. Evaluation of Performance in
Practice

Demo to pts, public, profession
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Safe, effective, pt centered, timely, efficient, equitable
health care
Improve quality of PC
CI of practice performance
Evaluate

Individual physician performance
Part IV. Evaluation of Performance in
Practice - ABMS Principles

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Phase-in; evaluate effectiveness; improve
Reflect activities of diplomate
Assessment based on


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EBM/guidelines
Expert consensus
Normative peer comparisons
Part IV. Evaluation of Performance in
Practice- ABMS Principles

Compare diplomate to standards
•
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Baseline, plan to improve, measure
Assess all 6 competencies during cycle
Key disease or clinical processes
Collaborative/shared databases
Proven educational & assessment methods
MOC for inactive and no PC MDs
Part IV. Evaluation of Performance in
Practice - ABMS Principles

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Provide feedback to improve PC, workflow,
efficiency
Not be duplicative-P4P
Collaborate with specialty societies
Begin assessment during residency
Part IV
Performance in Practice

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Four personal attestations (4th and 8th year)
Lab accreditation (4th and 8th year) except
forensic labs
Laboratory participation in inter-laboratory PI
programs (2 yrs)
Individual participation at least 1 laboratory PIQA program/yr. (2 yrs)
Part IV
Performance in Practice



Society-sponsored programs or created by
departments/institutions
On-line application for Part IV programs
Programs must be ABP-approved
Part IV. Evaluation of Performance in Practice

Attestations as to:
 Interpersonal and communication skills
 Professionalism
 Ethics
 Effectiveness in systems-based practice
Part IV. Evaluation of Performance in Practice –
Interpersonal & Communication Skills


4th year after certification and at application for exam
Attestations from:
 ABP-certified pathologist
 Credentials Com or equivalent (e.g. CMO)
 Board-certified physician in another specialty
 Technologist or physician’s assistant (360)
Part IV. Evaluation of Performance in Practice
Laboratory Accreditation

Timeline: 8th-10th year with exam application

Document accreditation status of laboratory
Part IV. Evaluation of Performance in Practice
Laboratory Improvement

Every 2 years after certification

Documentation to ABP of successful
participation in inter-laboratory improvement
and quality assurance programs relevant to the
practice
Part IV. Evaluation of Performance in Practice
Individual Improvement & QA Activity



Every 2 years after certification
Documents individual participation in at least
one QA program/year relevant to professional
activities, or
Document use of appropriate protocols,
outcome measures, & practice guidelines to
improve practice
Quality Improvement System
Quality Measure
Goal
Time
Collect
Performance
Measures
Report to
Board,
Payer, or
Patients
Analyze &
Compare
Performance
Change a
Practice
Process
Six Core Competencies In Medical Practice
Medical knowledge
 Patient care
 Interpersonal and communication skills
 Professionalism
 Practice-based learning and improvement
 Systems-based practice

Involvement of Specialty Societies in
MOC


ABP --standard setting organization
Cooperating Societies:
CME
 Self-assessment tools
 Programs for evaluation of practice performance
 Verification of satisfactory performance
 Remedial education programs
 Content

MOC Cost to Diplomates




Fee for electronic database
 $50/year
CME
Self-assessment modules
Cognitive exam
 Currently $2200
Requirements For MOC Parts I-IV
Part I: Professional Standing
Part II: Life-Long Learning and Self-Assessment
Part III: Cognitive Expertise
Part IV: Evaluation of Performance in Practice
Failure to meet MOC Requirements

Must participate and demonstrate satisfactory
performance in all 4 parts of MOC

Performance below expectations requires an
implementation plan to improve performance

Failure to satisfy performance criteria results in
loss of certification December 31st of 10 year
anniversary of initial certification
Transition to MOC

Holders of life-time certificates:
Voluntary recertification
 Participate in MOC
 Original certificate NOT jeopardized


Holders of time-limited certificates:


Must participate in MOC
Candidates for initial certification:

Must participate in MOC after certification
Voluntary
Recertification
and MOC
Voluntary Recertification




1998 ABMS initiative
Assessment of individual credentials
Measure quality of professional practice
Evaluate basic parameters of practice
Voluntary Recertification




Diplomates of ABP with non-time-limited
certificate
Recertification certificate dated January 1 of the
year following completion of process
Valid for 10 years
Expiration--no effect on original certificate
Voluntary Recertification Requirements



Possess lifetime primary certificate
Current valid, full, and unrestricted license to practice
medicine or osteopathy in US, its territories, or Canada
Provide a written statement attesting physically and
mentally ability to practice pathology
Voluntary Recertification Requirements

150 CME credits during the 3 years prior to
application
100/150 hours must be Category 1
 80/100 Category 1 hours must be directly related to
practice


Verify that primary laboratory or work environment
is accredited
Voluntary Recertification Requirements
Written statement documenting medical staff
standing
 References from the head of the department or
section chief and from chief of the medical staff
 Demonstrate membership in appropriate
professional organizations

Recertification Examination

Optional secure examination

Computer based, ABP test center

May be mandatory if candidate does not fully
meet the other requirements
Voluntary Recertification vs MOC

Requirements differ in degree

CME
VR – 150 hours in 3 years prior to application;
100 Category 1
 MOC - 25 hours/yr, all Category 1 AND 1 SAM /yr for
10 years
 80% of CME related to practice

Voluntary Recertification vs MOC

Practice evaluation
VR – licensure, references, laboratory accreditation,
medical staff standing, quality of practice assessed
by references
 MOC – licensure, references, laboratory
accreditation, inter-laboratory improvement and QA
programs, individual improvement and QA
programs

Voluntary Recertification vs MOC

Examination
VR – voluntary, (now) secure, combined AP and CP
questions
 MOC – mandatory, secure, closed-book exam,
modular

Voluntary Recertification vs MOC

Consequences
VR – failure to meet requirements or decision not to
recertify subsequently has no effect on original
certification status
 MOC – failure to meet requirements results in loss
of certification

MOC-Special Circumstance Physicians
 Not
in active practice
 Must complete MOC Parts I, II, III
 Will not need to complete Part IV
MOC
Unanswered Questions
 MOL
 Hospital
Credentialling
 Health Plan Credentialling
AMERICAN BOARD OF
PATHOLOGY
<www.abpath.org>