From the ABOto: MOC 2012 Update

The American Board of Otolaryngology (ABOto) has made major revisions to its Maintenance of Certification (MOC) program. I would like to share them with ENT Today readers. These changes involve rolling out Part IV (the final component of MOC), a new publishing partner for the MOC program, changes to the Part III exam and a new pricing structure.

MOC is a program established by the American Board of Medical Specialties (ABMS) in 2002 to address the growing demands of patients, the government, payers and others to ensure that certified physicians remain up to date on the latest information and work to improve the quality of health care. The ABOto, as one of 24 ABMS member boards, has developed its MOC program over the past decade, following ABMS guidelines.

Every member board has developed its own specialty-specific program, which is divided into four parts. The ABOto has implemented the first three components, which are defined as follows:

MOC is a non-punitive program designed to encourage lifelong learning and improve patient care.

—Robert H. Miller, MD, MBA

• Part I—Professional Standing: The MOC participant must complete an annual professionalism questionnaire and maintain an unrestricted medical license in each state in which he or she practices.
• Part II—Continuing Education and Self-Assessment: The participant must obtain 25 CME units annually and complete an online self-assessment module (SAM). The SAMs are practice focus-specific and include an expert panel video discussion on the topic. Eight new modules are created each year, in conjunction with the pertinent specialty society’s input and review.
• Part III—Cognitive Examination: The participant must pass a secure, closed book, computer-based exam during the last three years of the 10-year cycle. The exam consists of clinical questions only—no basic science—that are practice focus-specific. The number of Clinical Fundamentals (CF) questions has been reduced from 12 to three, as noted below.

What Changes Will Take Place Over the Next Six Months?

1. The Part II self-assessment modules will be published by Wiley-Blackwell beginning in January 1, 2013. The modules will be available directly through the ABOto website so that participants will not need to go to another site to obtain them. Additionally, an education module on the topic of the SAM will be added. Finally, the modules will be included in a single annual MOC fee, so there will not be a separate charge for Part II.
2. The ABOto has determined that the vast majority of the CFs would be better covered in educational seminars rather than by questions on the exam. These seminars are being developed by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), and will be available online and at the AAO annual meeting in September. Two CF topics (evidence-based medicine and anaphylaxis) will be covered in mini-seminars during the 2012 meeting. Other topics will be covered during future meetings and all of the seminars will ultimately be available online through the AAO-HNS. Only three topics will remain on the MOC Part III exam:
   • Emergency airway management;
   • Local anesthesia/conscious sedation; and
   • General post-operative management (e.g., post-operative myocardial infarction recognition).
3. The ABOto will roll out the last section of MOC, Part IV—Performance in Practice. Part IV will consist of three components: a patient survey, a professional survey and a Performance Improvement Module (PIM). The PIMs, which are being developed in partnership with Wiley-Blackwell and CECity, a company that has worked with other certifying boards in the development of their MOC programs, are based on the classic quality improvement cycle of measure, analyze, implement changes and re-measure. At least two to three PIMs ultimately will be available in each of the practice focus areas. To complete the module, the diplomate will enter select data about a series of patients with a given condition into an online system and receive feedback comparing the results with available guidelines or measures, as well as with other otolaryngologists who complete the PIM. If an area that could be improved is identified, the diplomate can use this information to improve his or her practice. The diplomate can then re-measure to show there has been improvement in practice. In addition, there will be a link to an educational module for additional background information. Currently, the plan is to require completion of a PIM once every three to five years.
4. With the addition of Part IV and the consolidation of the module production with Wiley-Blackwell and CECity, the ABOto MOC program is complete, creating an opportunity for a single annual fee to replace the current per-item charge. Under the old program, a diplomate would pay an average of $350 per year for Parts I through III. Under the new arrangement, the ABOto will reduce the fee to a single, $310 annual fee that covers all MOC components, including Part IV.

MOC is a program designed to encourage lifelong learning and improve patient care. All diplomates certified and subcertified since 2002 are required to participate. Those certified earlier than 2002 can voluntarily participate. ABOto directors, all of whom were certified prior to 2002, voluntarily participate to show their support for MOC.