Rebecca L. Johnson, MD Chair, Pathology & Clinical Labs Berkshire Health Systems

1. Rebecca L. Johnson, MD Chair, Pathology & Clinical Labs Berkshire Health Systems President, American Board of Pathology

2. MOC MAINTENANCE OF CERTIFICATION - WHY SHOULD I CARE?

3. History of Board Certification • 1908 Derrick Vail, MD • Presidential address to the American Academy of Ophthalmology & Otolaryngology • “I hope to see the time….let him then be permitted and licensed to practice ophthalmology.”

4. American Board Of Ophthalmology • Am. Ophthalmologic Society, AMA, Academy of Ophthalmology • 1915—Defined requirements • 1917—ABO established

5. Early Boards • 1924—Am Board of Otolaryngology • 1930—Am Board of Obstetrics & Gynecology • 1932—Am Board of Derm & Syphilology • 1933—Am Board of Pediatrics • 1934—Psychiatry & Neurology, Radiology, Orthopedic Surgery • 1935—Colon & Rectal Surgery, Urology • 1936—Internal Medicine, PATHOLOGY

6. Advisory Board For Medical Specialties • Est. 1933 • Uniformity in MD certification • Increase public awareness • Education, training, and certification

7. Advisory Board For Medical Specialties • Four first specialty boards • AHA, AAMC, FSMB, AMA Council on Med Ed & Hospitals, NBME • 1970 - American Board of Medical Specialties (ABMS)

8. ABMS Purpose • Discuss common issues • Advise Boards • Coordinate work • Jurisdiction over policies as delegated • Autonomy of any Board • Stimulate improvements in med ed

9. ABMS • 24 Boards • 37 Primary specialties • 94 Subspecialties • 2005 ~89% licensed US MDs • Evanston, IL • Kevin Weiss, MD, EVP • www.abms.org

10. ABMS MISSION • Improve quality of medical care • Professional and educational standards for certification • Assurance to the public • Certification has meaning and required components

11. ABMS & Member Boards • Assess • Education, Training, Licensure, Ethical and professional requirements • Initial examination • Construction-fair, objective • Psychometrically reliable and valid • Assess knowledge & clinical skills

12. Limits of Board Certification • Assesses only medical knowledge • Snapshot SOLUTION? • Recertification • Time limited certification • Maintenance of Certification (MOC)

13. Evolution from Certification to MOC 1936 1969 2006 2016 Unlimited Certification Time-Limited MOC Re-Certification

14. ABMS • 1993 Member Boards agree to Recertification • 1997/98 ABPath Voluntary Recertification

15. 1998 ABMS Task Force on Competency • Mission statement—Diplomates are competent • Define competence • Research and assessment, validation • Template to assess competence • Peer review of certification • Collaborative methods of assessment

16. GOALS • MOC Relevant • Accountability for competence • Accountability for practice quality • Reshape Continuing Medical Education • MOC is Essential; Tied to: • Hospital Credentialing • Maintenance of Licensure • Pay for Performance

17. Three Trends Make MOC Relevant • Public wants accountability for performance • Purchaser decision about quality • Quality can be measured • Patient’s perceptions and health status • Guideline adherence and achieving outcomes • Quality can be improved • Health care results from system • Change system processes improves care

18. Relevance of MOC For A Composite Measure of Physician Quality • Customers • Healthcare purchasers & patients • Health plans, medical staffs, group practices • Competitors • National Committee for Quality Assessment • Center for Medicare and Medicaid Services • Doctor Quality web sites • Collaborators • JCAHO • State Medical Boards/FSMB

19. Autonomy Collaboration Authority Evidence Assertion Measurement Control Transparency Changing View of Professionalism

20. Accountability • Develop evidence of achieving best results for patient care • Communicate results regularly and widely to those to whom accountability is owed Profession Public

21. ABMS & ACGMELifetime Competencies • MEDICAL KNOWLEDGE • PATIENT CARE • INTERPERSONAL & COMMUNICATION SKILLS • PROFESSIONALISM • PRACTICE BASED LEARNING & IMPROVEMENT • SYSTEMS BASED PRACTICE

22. MOC – A Composite Measure of Competence and Quality Safe Timely Efficient Effective Equitable Patient Centered Competencies IOM Quality Aims

23. Evolution of MOC • 1936--Certification • Training • Competence/Practice • Examination • 2006 - Maintenance of Certification • Certification after training • Milestone evidence of competence • Professional standing • Lifelong learning & self-assessment • Cognitive expertise • Practice performance & improvement • Can apply to all certificates • Single credential • Board Certification • Maintenance of License • Hospital Privileges • Public accountability • 1998 Voluntary Recertification • CME • License & privileges • Examination (optional)

25. American Board of Pathology • 1936 Michigan • Primary Certification • AP/CP, AP, CP • Subspecialty certification • 10 • ACGME approved fellowship • Change in training requirements

26. AMERICAN BOARD OF PATHOLOGY • PRIMARY CERTIFICATION • ANATOMIC & CLINICAL PATHOLOGY • ANATOMIC PATHOLOGY • CLINICAL PATHOLOGY

27. AMERICAN BOARD OF PATHOLOGY- SUBSPECIALTY • Blood Banking/Transfusion Medicine • Chemical Pathology • Cytopathology • Dermatopathology* • Forensic Pathology • Hematology • Medical Microbiology • Molecular Genetic Pathology* • Neuropathology • Pediatric Pathology

28. ABP Cooperating Societies • ACLPS • ADASP • AMA Pathology Section Council • APC • ASCP • ASIP • CAP • USCAP

29. Maintenance of Certification • ABMS initiative • All 24 specialty boards • 2006 -Time-limited (10 year) primary and subspecialty certificates • Participation in MOC process required • Completed within 8-10 years

30. ABMS BoardsRecertification

31. MOC Components • Professional Standing • Lifelong Learning & Self-Assessment • Cognitive Expertise (the EXAM!) • Evaluation of Performance in Practice

32. Part IProfessional Standing • Maintenance of a full and unrestricted license in at least one U.S. jurisdiction, territory, or Canada • Documentation of medical staff membership and privileges or, if not applicable, scope of practice • Documentation of licensure and medical staff privileges at 4th and 8th year

33. Part IILife Long Learning- Self-Assessment • 70 Category 1 CME credits / 2 year cycle • 20 CME credits / 2 yr cycle must be SAMs • 80% CME related to individual’s practice • Updated electronic record of activities every 2 years • A fellowship fulfills Part II requirements for 2 year period • Incomplete fellowships prorated

34. Part IILife Long Learning and Self-Assessment • Content specifications • Important advancements, key concepts • Basis for CME and self-assessment • Prep for MOC exam. • Direct MOC test question development • Practical “need to know” information, used in daily practice, required for competence • Cover all disciplines of pathology

35. Part IILife Long Learning-Self-Assessment • AP and CP Content Committees’ “Content Outlines” on line, updated annually • Fundamental information for daily practice; important, validated new knowledge • Outlines are not templates for exam or endorsements of authors

36. Self-Assessment Modules (SAMs) • Elements of SAMs • Educational product • Self-administered exam • Minimum performance level • Feedback • SAM requirement for 2006-09 period waived because of insufficient offerings • Certificates issued by societies should reflect regular CME versus CME / SAM

37. Part III--Cognitive Expertise • Examination is mandatory • “Secure” and closed book • At least once per year • Taken 8-10 years after initial certification • Potential 3 year period of qualification

38. Part III - Cognitive Expertise • Modular exams related to practice • Exams will include: • Fundamental knowledge • Current practice-related knowledge • Emphasis on information new to field • Practice environment knowledge

39. Part IIICognitive Expertise • AP/CP certified individuals may chose to maintain their certification in AP/CP, AP only or CP only • Individuals with subspecialty certification may choose to maintain only their subspecialty certification

40. Part IIICognitive Expertise MOC exam: • “tailor” exam to practice by selecting modules. • Menu of multiple modules • At least one general module of AP or CP must be selected by AP/CP examinees

41. Part III - Cognitive ExpertiseMOC EXAM • 6 modules of 25 questions (150 total questions) • 80% practical (virtual microscopy, case-based questions etc); 20% written • Modules graded as one exam

42. AP/CP MOC Exam + + + + 4 add. = 6 total + 3 add. = 6 total + 3 add. = 6 total Option 1 Option 2 Option 3 CP General module AP Specialty module

43. AP only MOC Exam CP only MOC Exam + + oror or or or or or or or or 3 max 6 total 6 total CP General module Specialty module AP

44. ModulesClinical Pathology

45. ModulesAnatomic Pathology Revised 11/08

46. Revised 11/08 ModulesAnatomic Pathology cont’d

47. Revised 11/08 Common Modules*Anatomic and Clinical Pathology * May be used to fulfill AP or CP specialty modules

48. Part III—Exam & MOC Myths • High stakes—Low failure rate • Irrelevant—Modular • Not useful—Improves MK, Pt. Care • Time consuming—Payoff- meet pt and regulatory expectations for quality, accountability, self-regulation

49. Part IV. Evaluation of Performance in Practice • Demo to pts, public, profession • Safe, effective, pt centered, timely, efficient, equitable health care • Improve quality of PC • CI of practice performance • Evaluate • Individual physician performance

50. Part IV. Evaluation of Performance in Practice - ABMS Principles • Phase-in; evaluate effectiveness; improve • Reflect activities of diplomate • Assessment based on • EBM/guidelines • Expert consensus • Normative peer comparisons