- Maintenance of Certification (MOC)
Maintenance of Certification (MOC) is the process of keeping physician certification up-to-date through one of the 24 approved medical specialty boards of the
American Board of Medical Specialties (ABMS). The ABMS, a non-profit organization, is one entity overseeing physician certification in the United States.
The Maintenance of Certification program provides an ongoing process that was designed to help physicians keep abreast of advances in their fields, develop better practice systems, and demonstrate a commitment to lifelong learning. Physicians need to have - and maintain - the clinical judgment and skills upon which high quality care depends. Fact|date=December 2007
Maintenance of Certification and the Medical Community
Many major medical organizations have expressed support for the Maintenance of Certification program as a valuable means of facilitating physicians' continuous professional development and measuring physicians' continued competency, including the following:
[http://www.abms.org/ The American Board of Medical Specialties (ABMS)] [http://www.ama-assn.org/ The American Medical Association] [http://www.aha.org/ The American Hospital Association (AHA)] [http://www.nbme.org/ The National Board of Medical Examiners (NBME)] [http://www.fsmb.org/ The Federation of State Medical Boards (FSMB)] [http://www.cmss.org/ The Council of Medical Specialty Societies (CMSS)] [http://www.acgme.org/ The Accreditation Council for Graduate Medical Education (ACGME)] [http://www.aamc.org/ The Association of American Medical Colleges (AAMC)] [http://www.ecfmg.org/ The Educational Commission for Foreign Medical Graduates (ECFMG)]
Maintenance of Certification Competencies
The Maintenance of Certification program assesses the six general competencies identified through the [http://www.acgme.org/Outcome/ ACGME Outcome Project] and subsequently required in medical residency program evaluations:
* patient care
* medical knowledge
* practice-based learning and improvement
* interpersonal and communications skills
* systems-based practice
Maintenance of Certification Components
Maintenance of Certification incorporates the ACGME competencies through four program elements:
* Professional Standing: Physicians must have a valid, unrestricted license to practice medicine and confirmation of good standing in their local practice community.
* Lifelong Learning and Self-Assessment: Through open-book examinations developed by ABMS member Boards, medical societies, and others, physicians assess their clinical and practical knowledge. This component stimulates learning, requires that physicians document their learning, and ensures that physicians keep up with the rapidly evolving medical knowledge essential to quality patient care.
* Cognitive Expertise: Physicians are required to pass a closed-book, proctored examination in their specialty area that assesses critical aspects of clinical knowledge and judgment in scenarios like those encountered in physician practice. This examination evaluates not only what physicians know, but how they use what they know to promote health, diagnose and treat illness effectively and efficiently.
* Practice Performance Assessment: Physicians use tools to self-assess their performance in medical practice, with an emphasis on patient care quality, measurement, and documented quality improvement. These assessment tools include various Practice Improvement Modules (PIMs) that evaluate physicians' performance in a clinical area relevant to their practice, compare their performance to clinical guidelines, help them to develop a plan to improve important aspects of their practice, and assess the impact of that improvement plan.
Maintenance of Certification and Other Stakeholders
Increasingly, many health plans are implementing programs that recognize and reward physicians who are actively participating in Maintenance of Certification activities. [http://www.abim.org/pressroom/press_release/08_07_07_NHCO.shtm Four National Health Care Organizations to Use American Board of Internal Medicine (ABIM) Board Certification Tools in Their Physician Recognition Programs] . American Board of Internal Medicine press release, August 7, 2007. ] ABMS member boards are actively working with other health care organizations to advance quality initiatives and reduce measurement redundancy through recognition of physicians' Maintenance of Certification program participation. Hospitals and health systems are beginning to use Maintenance of Certification components to engage physicians in quality improvement.
Studies suggest that board-certified physicians provide improved quality of patient care and better clinical outcomes than those physicians without board certification, [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1828098 Physician Board Certification and the Care and Outcomes of Elderly Patients with Acute Myocardial Infarction] . Journal of General Internal Medicine. 2006 March; 21(3): 238–244.] including a 15% reduction in mortality rate among heart attack patients treated by board-certified physicians. [http://www.academicmedicine.org/pt/re/acmed/searchresults.htm;jsessionid=GPlfpG7bfcqfxG2J4NVR20mGdGNS9zh2lLFpZTv2vM9NLRckXqLR!319339476!181195628!8091!-1?&index=1&results=1&searchid=3 The Certification Status of Generalist Physicians and the Mortality of Their Patients After Acute Myocardial Infarction] . Academic Medicine: Journal of the Association of American Medical Colleges. 2001 October; 76(10) Supplement: S21-S23. ] Considering a recent meta-analysis that shows a decline in physician performance associated with the time elapsed since the physician's initial training, [http://www.annals.org/cgi/content/abstract/142/4/260 Systematic Review: The Relationship between Clinical Experience and Quality of Health Care] . Annals of Internal Medicine. 2005 February; 142 (4): 260-273.] it is essential for physicians to participate in programs such as Maintenance of Certification in order to keep current with medicine's expanding knowledge base and technical advances, and to apply this knowledge to quality improvement in their medical practice. Maintenance of Certification helps physicians and other health care stakeholders address the critical need to enhance patient safety and patient care quality. [http://www.abim.org/pressroom/press_release_pdf/JAMA%20Article%20090104.pdf The Role of Physician Specialty Board Certification Status in the Quality Movement] . Journal of the American Medical Association (JAMA). 2004 September; 292(9): 1038-1043.]
Ironically and fairly hypocritically, many of the certifying boards, such as the American Board of Internal Medicine and the American Board of Pediatrics, have "grandfathered" physicians certified prior to circa 1990, ie there is no requirement for such physicians to recertify. These are, of course, the very physicians who have had substantial time elapse since their training and so, as implied above, are deliverers of inferior care. Astoundingly, many of the current members of both boards have chosen not to recertify themselves although this is recommended by the very boards of which they are members.
American Board of Medical Specialties (ABMS) American Board of Family Medicine (ABFM) American Board of Internal Medicine (ABIM)
* [http://www.abms.org/About_Board_Certification/MOC.aspx Official ABMS Maintenance of Certification Website]
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