ABIM announces changes to MOC assessment
In response to criticism that its Maintenance of Certification (MOC) exam is too time-consuming, the American Board of Internal Medicine (ABIM) recently announced plans to offer a new option that will allow physicians to take a shorter assessment exam beginning in 2018.
The specific details of the new assessment option have yet to be finalized; however, ABIM says the shorter assessments will be taken more frequently than the current eight-hour assessment every 10 years, but no more than annually. Additionally, physicians will be allowed to take the assessment on their own secure personal or office computer and will receive feedback to address their knowledge gaps. Physicians who perform well enough on the shorter assessments will also not be required to take the 10-year exam to remain board certified.
"By offering shorter assessments that they could take at home or at the office, we hope to lower the stress and burden that many physicians have told us the current 10-year exam generates," says ABIM President and CEO Richard J. Baron, MD.
This change addresses one of the key recommendations made by ABIM’s Assessment 2020 Task Force, which issued its final report in September. Among its recommendations was replacing the 10-year exam with more frequent assessments, taken at home or in the office.
The Assessment 2020 report explained, "The results of the smaller, more frequent, lower-stakes assessments would provide insight into performance and accumulate over time and culminate in a high-stakes pass/fail decision … This approach would emphasize learning as an integral part of the program, but would also provide meaningful criteria to the public as to whether a physician is remaining current."
ABIM plans to initially make the shorter assessment option available only to physicians maintaining certification in internal medicine and possibly a few subspecialties. Feedback from early adopters will be used to help make the new assessment option available to more subspecialties in the future.
Physicians who do take the short assessments but don’t meet a passing standard over a period of time, which ABIM has yet to determine, will be required to take the traditional longer assessment.
Survey results
The move to shorter, more frequent assessments was supported by the results of ABIM’s survey of more than 9,200 board-certified physicians about potential changes to the MOC assessment, the results of which were released in April.
The survey found:
- 56% of respondents had a positive reaction to the idea of a shorter knowledge assessment taken more frequently, compared to roughly 30% who responded negatively.
- More than 86% reacted positively to the idea of taking the exam at their home, office, or elsewhere using a secure computer connection instead of going to a testing center. Only about 7% had an unfavorable view.
- For alternate testing locations, the majority of respondents preferred their home or office (87%), followed by a local medical center or hospital (34%). Only about 21% found going to a dedicated secure test center favorable.
- Nearly 80% said they would take a series of shorter assessments over the course of a few years that would allow them to skip the traditional MOC exam if they performed well enough, even if the current eight-hour assessment taken once every 10 years still existed.
Diving further into assessment length and frequency preferences, the survey found that the majority of respondents preferred assessments requiring less than an hour of time and taken every year (55%), followed by two- to four-hour assessments taken every few years (45%). And, despite the overwhelming preference for the shorter assessment, nearly 21% of respondents still liked the 10-year assessment, Baron says, which is why the ABIM is keeping it as an option. "Our announcement reflects these divergent views and gives physicians the chance to choose the assessment that best meets their needs."
The survey also found that 76% of respondents had a favorable view of accessing online reference material during an assessment. Nearly two-thirds favored having access to online reference material they used in practice. Respondents had less favorable views of limiting online reference access to certain sections of the assessment (44.4%) and limiting the amount of time to complete the assessment using references (47.6%).
In its announcement for the new assessment option, ABIM said it will continue to study the feasibility of offering open-book assessments.
Pricing for the more frequent assessments has not yet been determined. ABIM will be redesigning its fee structure as it redesigns the assessment model and looking to provide payment options for each program track.
Reaction to the announcement
Baron says it’s too early to gauge the full extent of the reaction to the new assessment option, "but for the past year, we have been hearing from doctors that they are very interested in having assessment options. And the reaction to the announcement has been generally positive so far."
Some members of the physician community see the new option as a necessary correction to a program that’s viewed by many as too burdensome.
"There needs to be a balance between ‘opposite poles’ or things will swing too far one way or the other. The initial intent for MOC was a good one but went way too far and became an onerous proposition rather than an ongoing badge of honor. This move by the ABIM to move to a centrist position is a good one." says William K. Cors, MD, MMM, FACPE, chief medical officer of Pocono Health System in East Stroudsburg, Pennsylvania. "It restores some balance to the equation of maintaining an ongoing bar of certification on the one hand and not representing a near-impossible life challenge to the physician on the other hand. Sometimes reason prevails and both poles of a proposition are in better alignment."
Steven Weinberger, MD, MACP, FRCP, American College of Physicians (ACP) executive vice president and CEO, also expressed support for reforming the MOC assessment.
"ACP is encouraged to hear that ABIM is considering alternatives to the 10-year secure examination for maintenance of certification, and that they are beginning to respond to the concerns we’ve raised on behalf of our members. We look forward to hearing more about the new approach, such as the frequency of the assessments, cost, and more about the feedback mechanism. The specifics of how the new approach is designed and implemented will be critical to its success in decreasing the burden and increasing the relevance of the current program," Weinberger says.
In a statement released by the American College of Cardiology (ACC) shortly after the ABIM announcement, ACC President Richard A. Chazal, MD, FACC, praised ABIM’s effort while remaining cautious.
"MOC continues to rank among the top concerns of our internal medicine members, with the 10-year examination being the largest obstacle … We applaud the ABIM’s move in the direction of more flexibility in MOC requirements; however, we will need more details to see how it aligns with ACC’s proposal," Chazal said.
However, regardless of ABIM’s new assessment option, MOC itself still has its detractors. "We object to MOC on principle," says Jane M. Orient, MD, executive director of the Association of American Physicians and Surgeons. "Doctors are professionals. They are supposed to know how to learn (or what good are the training programs?), and no one knows better than they do [of] what they need to know to best serve their patients."
Orient believes there is no evidence that patient care is improved by time-limited board certifications and likens it to the idea of time-limited MD degrees or requiring attorneys to pass the bar every 10 years.
What’s next?
Baron says over the next few months, ABIM will ask for feedback from physicians, societies, and other stakeholders to help it refine the new assessment model. Specific details will be provided to the community no later than December 31, 2016. Before the model’s implementation, ABIM will also hold a public comment period about the proposed changes.
"Understandably, we have received a few questions about what the new assessment option will exactly look like, and while we do not have all the details yet, we have tried to address some of the [frequently asked questions] online," Baron says.
In the meantime, physicians with certifications set to expire prior to the adoption of the new assessment option in January 2018 will still need to take the current exam.
Whether the new assessment option will make ABIM’s MOC program more attractive to physicians remains to be seen, but Baron says he is optimistic.
"[I]t is our hope that by working with physicians to create a new assessment option, more physicians will elect to participate in the MOC program," he says. "Over the past year, we have heard from many physicians who have said that they want a relevant and meaningful credential that signals to the public and to their peers that they are staying current with medical knowledge and practice. ABIM’s MOC credential offers this to them, and with the proposed changes, we hope more physicians will proudly choose to participate in ABIM’s MOC program."