WPSA Portrait of Dr Carol Burke taken on Skyway between Crile & Cole on 08-24-16 for Boyle
Dr. Carol A. Burke

Unanswered Questions Abound:
ABIM’s News on MOC

December 14, 2016

Today, the ABIM announced that, beginning in 2018, physicians certified in Internal Medicine can choose to take an every-two-year secured recertification examination for Maintenance of Certification in lieu of the 10-year exam. The timing and format for any alternatives to the 10-year recertification examination for specialists are not known.

The new pathway presented by the ABIM appears to fall short of the principles the College has consistently outlined to the ABIM in terms of MOC, based on the information available. The ABIM shrouds the reality of an every-two-year secured examination option as a “knowledge check-in” and a “low-stakes” assessment.

Call it like it is: an option for a more frequent, secured, high-stakes, consequential examination that has no strong evidence of proven value to diplomates or our patients.

ACG has consistently communicated the concerns of our members directly to the ABIM and has worked with other organizations across internal medicine, including the other GI societies, to ensure that the MOC process is less complicated, more clinically relevant and less expensive for those who wish to maintain board certification.

Specifically, the College has outlined to the ABIM that any knowledge assessment should allow clinicians to utilize all resources that would be available for use in practice, demonstrate a commitment to lifelong learning rather than lifelong testing, focus on knowledge relevant to practice, and have a cost commensurate with value in terms of time, money, or professional consequences.

ACG’s message to ABIM has been loud and clear: MOC in its current and proposed form places unreasonable burdens on participants in terms of unjustifiable cost and inconvenience, and detracts from patient care.

From today’s announcement, it is not clear that ABIM heard the message. We are left wondering why the ABIM is still “exploring” making two-year assessments open book; focusing assessments on a subset of knowledge relevant to practice (versus breadth of knowledge in a certain discipline); and “exploring” partnerships with societies to create additional options. The ACG and our sister societies have been at the ABIM table and offered alternatives, but have had no substantial engagement with the ABIM on moving the needle.

ACG’s Principles: MOC be must be simpler, less intrusive and less expensive

As the College has shared with ABIM on many occasions, we believe GI physicians should be held accountable as lifelong learners, not lifelong test takers.

As I wrote recently in a blog post to ACG members, “The bioptic assessment of medical knowledge by a stressful, high stakes, secured recertification test whether it be at two, five or ten years, is no measure of the quality and effectiveness of the care we provide to our patients. Moreover, it does not reflect the process by which we obtain medical information to manage our patients…Consistently, diplomates advise me that many of the ABIM recertification questions continue to be irrelevant and do not reflect the common diseases and disorders we see day-to-day in our patients.”

Incremental Improvement, But Questions Remain

While with this new option from ABIM for Internal Medicine diplomates may offer an incremental improvement for some, there are still an enormous number of questions that remain unanswered for gastroenterologists regarding MOC overall and about the two-year testing scheme announced today.

The most salient question is whether ABIM’s new option meaningfully addresses critical concerns raised by ACG as to the relevance, cost, and overall burden of MOC.

Other questions include:

  • What is the timeline for the introduction of a new pathway for MOC for gastroenterologists?
  • What activities do diplomates need to complete between the two-year examination periods other than the secured examination?
  • What is the duration of the two-year examination and how many questions will be included?
  • Will the two-year secured examination cover the breadth of gastroenterology and hepatology as a shorter version of the existing 10-year exam?
  • What is being done to deal with the issues of relevancy of the exam?
  • How will the ABIM engage more effectively with the GI specialty societies to design a meaningful approach to knowledge assessment?
  • What is financial burden of the various pathways?

Until ABIM releases further details, arguably the largest questions looming are whether the MOC enterprise as presented by ABIM actually contributes to improved patient care or broadens the durable knowledge base of its diplomates.

— Carol