ABIM Offers a Less Burdensome Path to Maintenance of Certification

Richard J. Baron, MD

Responding to physicians who complained about burdensome new requirements for Maintenance of Certification (MOC), the American Board of Internal Medicine (ABIM) has promised to roll out a series of short assessments that could potentially be taken in the privacy of one’s home or office and via an open book exam. This alternative path to MOC would begin in January 2018. The existing, 10-year test would still be available as an option.

The new assessments would be taken no more often than once a year and at least once every 10 years.

“By offering shorter assessments that physicians 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,” ABIM President and CEO Richard J. Baron, MD, said.

Two years ago the ABIM sought to make continuous assessment a feature of the MOC. Physicians had long argued that the program was out of step with their professional needs, but they balked at the proposed changes, which they said would be much too burdensome.

Initially, the new assessment option would be available only to physicians seeking to maintain certification in internal medicine and possibly one or two subspecialties. The ABIM plans to offer additional subspecialties as quickly as possible. Home- and office-based assessment testing would be offered once the ABIM has worked out how to ensure security and verify the identity of the individuals taking the assessment.

One feature of the new program is that physicians would receive feedback following testing so that they can fill in knowledge gaps and remain current in their profession. Physicians who “engage in and perform well on these shorter assessments” would no longer have to take the 10-year assessment, the ABIM said.

The changes are partly based on an MOC survey that got as many as 9000 responses. The ABIM said hundreds of physicians are participating in the effort to develop a more acceptable assessment program.

The latest update on the revision makes no mention of 3 controversial elements that were a part of the original plan for more rigorous standards. Those included requirements that physicians improve elements of their practice and measure the results, demonstrate that they are incorporating the values and preferences of their patients into treatment activity, and demonstrate good foundational knowledge of patient safety, prevention techniques, and teamwork and care coordination.

The ABIM said that it will continue working with the internal medicine community to refine the latest assessment plan. “At a time when online credentials with no standards behind them are proliferating in many disciplines, doctors have told us they want us to continue to provide an MOC credential that says to their peers and to the public, in a credible and substantial way, that they are maintaining the knowledge they need to practice medicine,” Baron said.

The idea that physicians should be allowed to take open-book tests remains under consideration, the ABIM said. The group is also trying to figure out how to provide immediate feedback about knowledge requirements; and it continues to work with physician groups to develop ways in which their members can accrue continuing medical education (CME) credit.

Physicians with certifications that expire before the new assessment option is offered in their specialty would still need to take and pass the current 10-year exam to maintain their certification. “Most of these physicians will be taking an exam based on a blueprint updated for relevance and featuring other enhancements, including detailed score reports,” the ABIM said. “They will not have to take another assessment for 10 years.”

A public comment period will precede implementation of the new assessment program. More details will be offered on the plan by December 31, 2016, the ABIM said.

The plan for shorter assessments has met with tentative approval from the American Society of Hematology (ASH), which described the new plan as a “positive step forward.” The group’s official position for 14 years has been that the ABIM MOC requirements do not accurately reflect ASH members’ professional needs.

“The American Society of Hematology is pleased that the ABIM is responding to concern about the MOC as expressed by many hematologists,” ASH president Charles S. Abrams, MD, said in a statement. “However, hematologists uniformly note that any single exam or assessment does not recognize the diversification of career paths in the subspecialty.”

ASH said that assessments should be accompanied by links to material that physicians can study to learn whatever knowledge they are expected to know. It said certifying boards should “allow for customization of assessments to fit the needs of individual practitioners by giving options of either broad or narrow scopes of content, and link assessments to educational material already offered by specialty societies such as ASH.” More steps to modernize MOC are needed, ASH said, adding that it has urged the ABIM to make hematology a priority specialty as it launches the new assessment option.