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Maintenance of Certification (MOC®) and what it means to the ASSH Member

MOC(R) – General Background Information

Five Bullets of Truth about MOC(R) and ABOS Response

September 2006 Response to MOC(R) Member Questions

Please contact your specialty Board with questions regarding the MOC®

ABOS - American Board of Orthopaedic Surgery

Contact: G. Paul DeRosa, MD - (919) 967-8741

MOC tracking and CAQ Exam

Contact: Denise Scarboro - (919) 929-7103

For Diplomates of the ABOS (www.abos.org )

ABPS - American Board of Plastic Surgery

Contact: (215) 587-9322

For Diplomates of the ABPS (www.abplsurg.org )

ABS - American Board of Surgery

Contact: Dr. Robert Rhodes - (215) 568-4000

For Diplomates of the ABS (www.absurgery.org )

MOC® – General Background Information

The American Board of Medical Specialties (ABMS), of which the American Board of Orthopaedic Surgery (ABOS), the American Board of Plastic Surgery (ABPS) and the American Board of Surgery (ABS) are members, now requires a more comprehensive program for Diplomates of the Boards to maintain their certification.

This new program is termed Maintenance of Certification (MOC®) and it will replace the Recertification processes used by the individual Boards.

Why was MOC® developed?

MOC® was developed in response to external pressures from the Public, the Government, the Institute of Medicine, and other groups concerned about the quality of health care in the United States. The once-a-decade written test as a recertification process for physicians is no longer supportable in this era of rapidly changing information and technology. Public demand for greater assurance that physicians remain current and competent has led to the adoption of the MOC® Program by the members of the ABMS.

Each member Board of the ABMS has tailored its requirements for MOC® according to the scope of the Specialty. ABMS approval of the final form of the MOC® program for the individual Boards will occur this year. Implementation of the MOC® programs must occur as soon as possible so that all diplomates are fully participating by 2016.

What will MOC® look like?

MOC® for all medical specialties must evaluate the Four Components that define a competent physician. These include Evidence of Professional Standing, Evidence of Lifelong Learning and Self-Assessment, Evidence of Cognitive Expertise, and Evidence of Performance in Practice. Each Board will determine the methods of assessing these competencies for its Diplomates.

How does this impact ASSH members?

The members of the American Society for Surgery of the Hand (ASSH) are certified by one of three member Boards of the ABMS, and will have different requirements for MOC® depending on their parent Board.

ASSH members should be familiar with the MOC® requirements of his or her parent Board. A brief overview of the different requirements for the three involved Boards is presented in this paper. Because the ASSH requires a Subspecialty Certificate in Surgery of the Hand, known as the “CAQ in Surgery of the Hand,” there are special considerations for ASSH members in the MOC® process. ASSH members should refer to their primary Board for information on MOC. This information is posted on the Board websites.

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For Diplomates of the ABOS (www.abos.org)

The MOC® Program will continue to involve a ten-year cycle during which some aspects will remain the same or similar, and other aspects will involve change. The Credentialing process will remain largely unchanged. Continuing Medical Education (CME) requirements will involve cycles of topical CME and a new Self-Assessment Exam (SAE) component designed so that the Diplomate may direct study to address weaknesses. The secure, cognitive recertification examination options have been expanded to include practice profiled examinations, and for the Orthopaedic Board Diplomate, the Subspecialty Certifying Examination will also continue serve as a recertification pathway for the primary Orthopaedic Board.  Performance in Practice will initially be assessed through a case list submitted at the time of application for the recertification examination, and eventually through patient questionnaires that are being developed by the ABMS. The ABMS is developing the instruments that will be used by physician Diplomates of all the member Boards. Other requirements such as CME designated to deal with Patient Communication, Ethics, Cultural Competency, and CME designated by State Boards of Medical Examiners are likely to be added to the required MOC® process.

Participation in MOC® will become mandatory beginning with the ABOS Diplomates whose certificates expire at the end of 2010. The first opportunity to participate in the MOC® process will be with the credentialing and cognitive examination beginning in 2006 and 2007 respectively. For those Diplomates who wish to take the recertification examination as part of MOC® at the first available date, applications will be available on the ABOS website in 2006. The CME/SAE and case list components must be completed and reported prior to the application deadline. Please refer to the ABOS website for comprehensive information and details about the MOC® Program and how it applies to you.

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For Diplomates of the ABPS (www.abplsurg.org)

The MOC® Program will be offered on a voluntary basis to all ABPS diplomates certified before 1995.   After 1995, diplomates held 10 year time-limited certificates.  Recertification began in 2003.  Pending final approval by the ABMS, the transition from recertification to MOC® will occur in 2006-2007.  For example, the last recertifying examination will take place in the Spring of 2006.  All wishing to or required to recertify will do so through the MOC® process.  For example, those certifying in 2007 will embark on a 10 year MOC cycle.

The four components will be satisfied accordingly:

1. Professionalism – A full, unrestricted license to practice medicine, hospital admitting privileges to practice plastic surgery, recommendations from appropriate administrators, peer review, membership in one of the 21 sponsoring organizations of ABPS.  These are to be submitted to the ABPS every two years.
2. Life-long learning and self-assessment – 150 hours of CME over a three-year cycle. Self-assessment of practice will require completion of tracer procedure modules every 3 years.
3. Cognitive knowledge – Once every 10 years, diplomats will be required to pass a secure computer-based examination offered in a modular format that matches the diplomate’s practice profile.  Modules will probably include comprehensive plastic surgery, cosmetic surgery, craniomaxillofacial surgery, and hand surgery.  The examination content will be based on a pool of questions in the public domain (in-service exams, etc.).  Fifty questions will be standardized across the modules and 150 questions will be unique to the module. 
4. Performance in practice – still under development but likely to involve participation in a national data-base that tracks outcomes and a patient satisfaction instrument developed by ABMS.

What about plastic surgeons who hold time-limited subspecialty certificates in surgery of the hand as we transition to MOC®?    Currently, the ABPS plans to accept passage of the Subspecialty exam administered by the tri-partite committee of the ABS, ABOS, and the ABPS in lieu of the examination described above.  There is no plan at the moment to include any core plastic surgery specific questions in this examination (as is the case with ABOS.)   However, the questions for this examination will continue to be unique questions, not necessarily in the public domain.

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For Diplomates of the ABS (www.absurgery.org)

Participation in MOC® will be mandatory for all Diplomates who recertify in 2005 and thereafter and all individuals who initially certify in 2005 and thereafter.

Each of the four components of the MOC® Program of the ABS will be on a separate cycle that culminates in a secure examination every 10 years. 

1. Evidence of professional standing will be assessed every 3 years and will include documentation of an unrestricted license to practice, active hospital staff membership, and peer reference letters.
2. Evidence of Lifelong Learning and Self-Assessment will include 50 hours of CME activity yearly, of which 30 hours must be in ACCME Category I.  This will be averaged over a three-year cycle and the majority of the activity must be directly related to or within the broad area of the candidate’s area of certification.  The ABS will increasingly emphasize ‘active’ self-assessment over more ‘passive’ forms of CME. 
3. Evidence of Cognitive Expertise will continue as a secure examination on a 10-year cycle.
4. Evidence of Performance in Practice will include the reference letters that are part of the evidence of Professional standing plus evidence of assessment of practice performance.  Acceptable activities would include institutional participation in NSQIP, the Surgical Care Improvement Project, and/or review of practice processes and/or outcomes for frequent cases.  The latter will be particularly applicable to those seeking to recertify in Surgery of the Hand. Further evidence of performance in practice is likely to include assessment of communication and interpersonal skills through patient surveys.

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Prepared by ASSH MOC® Committee
Last updated March 2, 2006