Sunday, February 03, 2019

Evolving Board Certification

From the New England Journal of Medicine and the American Board of Anesthesiology, the MOCA Minute® (Cost $210/yr + 100/yr for subsequent certifications):
The MOCA Minute, a longitudinal assessment program introduced in 2016, enables anesthesiologists to identify their scope of practice and answer 30 practice-relevant multiple-choice questions per calendar quarter to continually assess their knowledge and problem-solving skills (see table). The questions focus on relevant information that physicians should know without having to consult references, so only 60 seconds is allotted for answering each question. After responding, physicians rate their level of confidence in their answer using a three-point scale (very confident, somewhat confident, or unsure). This system helps clarify what physicians know, when they are merely guessing, and where their blind spots lie. When physicians realize they have responded confidently yet incorrectly, they are more likely to engage in further education and retain knowledge. This process creates a data-driven basis for seeking out and completing appropriate CME. Questions answered incorrectly or with low confidence are repeated at varying intervals to maximize reinforcement and retention. After each response, physicians are told whether their answer was correct and are given a critique that includes the key point of the question and offers more information about the topic, literature references, and connections to corresponding CME.

From the American College of Cardiology, come the proposed Collaborative Maintenance Pathway® (CMP) (cost <$500/year):
Under the proposed CMP, the respective SAPs (self-assessment program) are expected to consist of 3 components: 1) a comprehensive didactic review of the entire discipline including written material, videos and slide decks that the learner may access in his/her own style and at his/her own pace; 2) a library of several hundred practice questions presented in a modular format corresponding to the topic area under study; and 3) a set of “performance” questions requiring a passing score, which will be made available on a modular basis when engagement with the learning material has been documented and when CME credits have been granted for the module. The didactic material of the SAP will be divided into 5 modules of approximately equal length, so that yearly assessments will cover approximately 20% of the discipline’s knowledge.

The entire CMP process is expected to provide, in a 5-year cycle, all the CME required for licensure in most states (∼25–30 h per year), all the medical knowledge (Part II) points required for MOC (100 points per 5 years), and a convenient, online assessment activity that will complete the MOC requirements for participating cardiologists (assuming a passing score on the performance questions for each of the annual modules).

It is anticipated that the discounted fee for the SAP component of the CMP will be priced approximately 25% lower than the cost of the current ACCSAP product. Members in good standing of the ACC, SCAI, HRS, and HFSA will all be eligible for the planned discount. ABIM fees will be assessed by the ABIM separately from the SAP component. The entire CMP (ABIM and ACC) process is expected to cost <$500 per year.
Finally, from the American Medical Association / American Board of Medical Specialties "Vision Commission" member and former Executive Vice President of the American College of Physicians:
The response to the MOC controversy has varied across the physician community from the extremes of acceptance of MOC to outright anger, with the flames of discontent often stoked by blogs and comments on social media. Within this spectrum of responses is a more centrist position, accepting the need for some sort of process that ensures ongoing professional development and competence as medical science evolves, but acknowledging that significant reforms are needed in the current MOC requirements.
Despite the many efforts to "modify," "adapt," "reform," Maintenance of Certification to new models, each of them has three huge flaws.
  1. There is no independent evidence-based proof that "maintaining" our initial board certification improves patient care or safety. Instead, there are now real examples before a federal judge of harm Maintenance of Certification has caused physicians.
  2. All of these programs result in little more than glorified rent-seeking that has proven remarkably lucrative for the ABMS, it's member boards, and physician specialty societies. Each proposed program fails to mention how testing data are shared with third parties, including (but not limited to) insurance companies and group purchase organizations like Premier, Inc. It is troubling that these demonstrated conflicts are never disclosed.
  3. Any computerized educational program that can restrict a physician's right to work based on completion of certain computer tasks is not acceptable to working physicians. This is not what education is about. "Centrists" are willing to accept voluntary, self-directed CME. They are not willing to accept a lifetime of expensive, coerced, directed CME on behalf of unaccountable and undisclosed third parties. Using the threat of loss of credentials and one's ability to work as a cudgel for physician participation not only is immoral and harms morale, it may be illegal and harmful to patients struggling to access their physician.
In summary, forcing physicians to look at more computer or cell phone screens for the financial benefit of medical bureaucrats distracts from what is really important: patient care. This has not changed. As such, Maintenance of Certification (MOC) - in whatever form proposed - must end.


P.S.: Please help support the legal fund created by Practicing Physicians of America to combat MOC.


Million Reasons To Say No To MOC said...

The ABMS has devolved

Their flagship medical specialty board (ABIM) is a gang of inveiglers and thieves (thugs).
Beware the online proctored Knowledge Check-in with its "personalized" frisk and pledge.
Watch out for the 10-year and 2-year threats to decertify you.
MOC® is a noose in their basket of tricks (MOC®TRIX).

Will Freedom said...

Freedom is integral to man. Cut the tethers and bands.

Will Wynn said...

Anti-MOC Fight

The PPA-sponsored class-action lawsuit against the ABIM was long overdue.
The amended anti-trust/anti-MOC complaint added RICO, unnjust encrichment and mail fraud to the complaint.

Support it.

W.O.R.M. said...

"...from the extremes of acceptance of MOC to outright anger, with the flames of discontent often stoked by blogs and comments on social media."

Dr. Steven E. Weinberger's comments above are quite laudable. Oops, I meant to say laughable. Except for the minority of ABIM sycophants, most EVERY physician I have spoken with do not 'accept' MOC. Rather, they are apathetic and resigned to forced participation in this program. Perhaps the good Doctor should spend some time out his ivory tower and actually have a chat with the little people he so knowingly speaks for. I also wonder what he would have to say in defense of ABIM's BIG LIE, namely that MOC is a 'voluntary' program.

Does outright anger exist over the chameleon-like MOC charade? You bet. But not to be dismissed by Weinberger's pejorative statements. I would more accurately describe it as a righteous anger born out of frustration and a terrible sense of injustice.

Anonymous said...

We agree that MOC is a charade. An incredibly elaborate one. How have they gotten away with it fir so many years? Where's the yellow tape?

MOCA MOB said...

Does anyone have a Java minute to read this! (MOCA Minute Skinny)

I love the new assessment buzzword "longitudinal". That word when used in the same breath as MOC immediately draws to mind the outlandish "paddle boards" used to discipline students in the not-too-distant past. Cutting through the lies the ABMS has propagated about maintenance of certification, we see MOC is little more than a painful tax - a long stiff painful board used for controlling the professional labor markets.

Anyone with common sense can see this. One can easily see through this word play scam.
ABMS MOC, or whatever latest palatable word they try to invent for MOC, it is all just a lot of BS. Hot wind poured over a cold stale cup of coffee. Fig leaves glued on the proud naked emperor who has his head in the sand.

Whatever newspeak or double speak the ABMS uses for their trademarked "labor intensifiers", the reality is they are all deceptive practices and monopolistic (arm twisting) manipulations of labor. Dirty tricks played on real human beings who are hurt. Patients and physicians.

How many mock words can the ABMS boards invent - trying to lull their captive customers to sleep? How many times will they keep trying to dupe, when all their trademarked words just spell "whack®"! in the end.

Anonymous said...

Censorship? Loss of constitutional guarantees? Whack®! Whack!®
Loss of privacy? Another Whack®!

Anonymous said...

1-THANKYOU Dr Wes for taking up this fight on behalf of all of us ; may God guide you and the lawyers on these cases breakup the illegal and corrupt evil ABIM Empire and destroy the MOC Death Star ! This is the dream of every sane doc in the USA !
2-Meanwhile we have to all keep up with getting CME credit for our state license requirements - I believe that most of us know that already that “uptodate “ is one of the simplest ways to get BOTH CME AND MOC very easily but for those who don’t know yet I want to publicize this again - I found that it is very simple on the UPTODATE system to get CME credit and get simultaneous equivalent abim MOC points credit for reading topics that I spend time on daily anyway in the process of patient care - Uptodate needs membership fees but this may be free or discounted via your hospital or other medical memberships ; uptodate automatically first tracks how many hours you are reading - then you choose to print a cme certificate to keep and then after clicking thru a few steps on their website - uptodate will electronically send to abim the same cme hours to give equivalent abim MOC hours credit ! I have only used uptodate for all my cme and Moc hours now and simply boycotted all the “society” meetings as unfortunately most of the medical societies are just playing along with abim to make money via moc granted by societies when we pay extra for “educational programs” or society meetings !!!
3-Have contributed financially to your Gofundme and I have asked all my colleagues to do so and I constantly ask them to read your Blog to keep up with the fight ; WAITING AND PRAYING for the day that the righteous Rebel’s will bring the whole system down on the heads of the the corrupt ABIM and all the other societies going along with this current stupid system.

Anonymous said...

MOC creates a disruption in the advancement of real professionalism in medicine.
What we have in the place of professionalism instead are mock professionals at the ABMS and its member boards advancing partisan political self interests on behalf of special interests.

Self enrichment is the motivational force driving the "executive staff" to maintain MOC.

Money interests and opportunism drives the ABMS umbrella and member boards' executives. In exchange for selling out they get lucrative contracts and certain verbal guarantees. When they cash in their position and take their chips in the high stakes game, executives get rewarded with lifetime guarantees of lucrative positions within the enterprise/franchise/syndicate and from the special interests they serve.

Case in point. Eric Holmboe gets an even more lucrative position, after violating physicians at the ABIM, at the ACGME.

Case in point. Kevin Weiss after selling out physicians via congressional testimony and helping launch attacks against physicians in 2009-2012 was rewarded with a sweet deal position at the ACGME. It is the same system supporting their associates for their machinations to professionalism and the professionals and the public they are supposed to be serving. (Mochinations against the patients' right to care.)

Case in point. Chris Cassel with all her conflcits of interests continues to be rewarded with an unjust enrichment program provided by her from the special interests she serves and the cronies who serve the same. (Cassel might have been indicted or sanctioned at any point for obvious violations of law and professional ethics, but instead a corrupt system protected her and still does to a degree.)

Take the obscene driving force of money out of the ABIM and watch the interest in MOC turn to dust and blow away. The "professionals" at the ABIM lost interest in certification long ago.

What a sham.

Case in point. When you look at the atrocious pass fail rates over a couple decades you can see the ABMS and member boards all lost focus and became out of touch with the professionals they used to claim to be one of. The ones they are supposed to serve as their own. The ABIM/ABMS lost touch with the public as well. It's all lip service with these MOC professionals turning a buck for themselves the easy way. Cheating! No reasonable human being would have allowed the money laundering/risk-driven investments/self enrichment/political manipulations that occurred in the dark at the ABIM and its bastard Foundation. Instead we got a gang of self-interested people with self-centric views of the world and zealous aims that helped mess everything up in healthcare today.

Professionals would never have allowed this if they were properly informed.

The first responsibility of a professional is to be properly informed. It take a lifetime of diligence, especially when those who would betray the profession and the public are in positions of authority.

How did trade associations ever get such absolute power to abuse? They operated in the dark. Now the internet has changed that. There is some light on this subject and lawsuits, even though there is a media blackout.

MD Fired for Sharing Insight said...

After writing an op ed in response to an article about the roles of physicians and nurse practitioners in medicine, an experienced pediatrician (working at a privately owned clinic in AZ) was summarily fired for allegedly violating the company policy regarding the "principal of mutual respect".

Censorship and retaliatory measures by a federally funded private clinic system. They attract physicians and nurses through HHS sponsored loan repayment programs. They clinics stay afloat with state and county funding as well.

Now their pediatrics department has two NPs and only one physician. I will not express any opinion on the matter out of fear of reprisal.